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ARTICLE |

The Relationship Between Neurally Mediated Hypotension and the Chronic Fatigue Syndrome

Issam Bou-Holaigah, MD; Peter C. Rowe, MD; Jean Kan, MD; Hugh Calkins, MD
JAMA. 1995;274(12):961-967. doi:10.1001/jama.1995.03530120053041.
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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 syndrome.

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° tilt; stage 2, 15 minutes at 70° tilt with 1 to 2 μg/min of isoproterenol; and stage 3, 10 minutes at 70° with 3 to 4 μg/min of isoproterenol). Patients were offered therapy with fludrocortisone, β-adrenergic blocking agents, and disopyramide, alone or in combination, directed at neurally mediated hypotension.

Main Outcome Measures.  —Response to 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.(JAMA. 1995;274:961-967)

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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