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Amplified amplitudes of circadian rhythms & nighttime hypotension in patients with Chronic Fatigue Syndrome (CFS): improvement by inopamil but not by melatonin

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By van de Luit L, van der Meulen J, Cleophas TJ, Zwinderman AH • www.ProHealth.com • November 12, 1998


Fatigue is an important symptom of a disturbed circadian rhythm. To
date, no studies of circadian rhythms in patients with chronic
fatigue syndrome (CFS) have been published. The objectives of
the study were to study rhythms of heart rate and systolic and
diastolic blood pressure in patients with chronic fatigue
syndrome compared with age-matched normotensive controls and
to study the effects of melatonin and inopamil on such
rhythms. Ambulatory blood pressure (ABP) measurements (Space
Lab, Inc, validated) of 18 patients with CFS were made
according to the 1987 U.S. Center for Disease Control
Criteria, and measurements of 12 age-matched normotensive
controls were used in a cosinor analysis of the two groups.

The effects of melatonin and inopamil on ABP were studied
subsequently in four patients in an 8-week open-label
evaluation. One patient was hypertensive (diastolic blood
pressure > 90 mm Hg at least once every 4 hours), and was,
therefore, excluded. The data of the remaining 17 patients (15
women, 2 men) revealed a significant 12-hour rhythm in heart
rate and 24-hour rhythm in systolic and diastolic blood
pressure with 95% confidence intervals not significantly
different from sinusoidal patterns. Although these rhythms
were synchronous with the control group rhythms, their
amplitudes were not and showed, respectively, 2.8, 2.8, and
9.0 times the size of the control group rhythms (p < 0.001, p
< 0.001, and p < 0.0001, respectively). Systolic blood
pressures in the patients with CFS were consistently below 100
mm Hg during the nighttime. In a subsequent pilot study of
four patients from the study population treated with melatonin
4 mg daily and inopamil 200 mg daily for 4 weeks, inopamil
reduced nighttime hypotension (p < 0.05), whereas melatonin
increased nighttime hypotension (p < 0.02). Patients with CFS
have increased amplitudes of circadian rhythms and systolic
blood pressures consistently below 100 mm Hg during the
nighttime. Positive inotropic compounds may be beneficial in
such patients, but melatonin may not be.




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