The relationship between neurally mediated hypotension & the Chronic Fatigue Syndrome (CFS)

OBJECTIVE–To compare the clinical symptoms and response evoked by
upright tilt-table testing in healthy individuals and in a
sample of those satisfying strict criteria for chronic fatigue

DESIGN–Case-comparison study with mean (SD)
follow-up of 24 (5) weeks.

SETTING–Tertiary care hospital.

PATIENTS AND OTHER PARTICIPANTS–A sample of 23 patients with
chronic fatigue syndrome (five men and 18 women; mean age, 34
years), each of whom fulfilled the strict diagnostic criteria
of the Centers for Disease Control and Prevention, was
recruited from regional chronic fatigue support groups and
from the investigators' clinical practices. There were 14
healthy controls (four men and 10 women; mean age, 36 years).

INTERVENTIONS–Each subject completed a symptom questionnaire
and underwent a three-stage upright tilt-table test (stage 1,
45 minutes at 70 degrees tilt; stage 2, 15 minutes at 70
degrees tilt with 1 to 2 micrograms/min of isoproterenol; and
stage 3, 10 minutes at 70 degrees with 3 to 4 micrograms/min
of isoproterenol). Patients were offered therapy with
fludrocortisone, beta-adrenergic blocking agents, and
disopyramide, alone or in combination, directed at neurally
mediated hypotension.

upright tilt and scores on symptom questionnaires prior to and
during follow-up. RESULTS–An abnormal response to upright
tilt was observed in 22 of 23 patients with chronic fatigue
syndrome vs four of 14 controls (P < .001). Seventy percent of
chronic fatigue syndrome patients, but no controls, had an
abnormal response during stage 1 (P < .001). Nine patients
reported complete or nearly complete resolution of chronic
fatigue syndrome symptoms after therapy directed at neurally
mediated hypotension.

CONCLUSIONS–We conclude that chronic
fatigue syndrome is associated with neurally mediated
hypotension and that its symptoms may be improved in a subset
of patients by therapy directed at this abnormal
cardiovascular reflex.

Bou-Holaigah I, Rowe PC, Kan J, Calkins H

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