This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Social Bookmarking   What's this?

Issam Bou-Holaigah, MD; Peter C. Rowe, MD; Jean Kan, MD; Hugh Calkins, MD

JAMA. 1995;274(12):961-967.

Abstract
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)

Author Affiliations
From the Departments of Medicine (Dr Calkins) and Pediatrics (Drs Bou-Holaigah, Rowe, and Kan), The Johns Hopkins University School of Medicine, Baltimore, Md.

Footnotes
Reprint requests to The Johns Hopkins Hospital, Carnegie 592, 600 N Wolfe St, Baltimore, MD 21287-0409 (Dr Calkins).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Seeking Answers to Chronic Fatigue Syndrome
Marsha T. Wallace, David S. Svahn, Michael Loudon, and Floyd Skloot
JAMA. 1998;279(21):1697-1698.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Hypertension and daytime hypotension found on ambulatory blood pressure is associated with fatigue following stroke and TIA
Harbison et al.
QJM 2009;102:109-115.
ABSTRACT | FULL TEXT  

Anaesthesia for patients with idiopathic environmental intolerance and chronic fatigue syndrome
Fisher and Rose
Br J Anaesth 2008;101:486-491.
ABSTRACT | FULL TEXT  

Aphrodite, sex and salt--from butterfly to man
Moinier and Drueke
Nephrol Dial Transplant 2008;23:2154-2161.
FULL TEXT  

Traditional Chinese Medicine for Chronic Fatigue Syndrome
Chen et al.
Evid Based Complement Alternat Med 2008;0:nen017v1-nen017.
ABSTRACT | FULL TEXT  

Successful Use of a Primary Care Practice Specialty Collaboration in the Care of an Adolescent With Chronic Fatigue Syndrome
Kuo et al.
Pediatrics 2007;120:e1536-e1539.
ABSTRACT | FULL TEXT  

Abnormal Thermoregulatory Responses in Adolescents With Chronic Fatigue Syndrome: Relation to Clinical Symptoms
Wyller et al.
Pediatrics 2007;120:e129-e137.
ABSTRACT | FULL TEXT  

Familial aggregation of fainting in a case-control study of neurally mediated hypotension patients who present with unexplained chronic fatigue
Lucas et al.
Europace 2006;8:846-851.
ABSTRACT | FULL TEXT  

Responses to Controlled Diesel Vapor Exposure Among Chemically Sensitive Gulf War Veterans
Fiedler et al.
Psychosom. Med. 2004;66:588-598.
ABSTRACT | FULL TEXT  

Neurally mediated hypotension in systemic lupus erythematosus patients with fibromyalgia
Tang et al.
Rheumatology (Oxford) 2004;43:609-614.
ABSTRACT | FULL TEXT  

Midodrine treatment for chronic fatigue syndrome
Naschitz et al.
Postgrad. Med. J. 2004;80:230-232.
ABSTRACT | FULL TEXT  

Sinus Tachyarrhythmias and the Specific Bradycardic Agents: A Marriage Made in Heaven?
Yusuf and Camm
J CARDIOVASC PHARMACOL THER 2003;8:89-105.
ABSTRACT  

The Neuroendocrinology of Chronic Fatigue Syndrome
Cleare
Endocr. Rev. 2003;24:236-252.
ABSTRACT | FULL TEXT  

Chronic Fatigue Syndrome: A Review
Afari and Buchwald
Am. J. Psychiatry 2003;160:221-236.
ABSTRACT | FULL TEXT  

The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome
Naschitz et al.
QJM 2003;96:133-142.
ABSTRACT | FULL TEXT  

A Measure of Heart Rate Variability Is Sensitive to Orthostatic Challenge in Women with Chronic Fatigue Syndrome
Yamamoto et al.
Exp. Biol. Med. 2003;228:167-174.
ABSTRACT | FULL TEXT  

The Symptoms and Signs of Upper Airway Resistance Syndrome: A Link to the Functional Somatic Syndromes
Gold et al.
Chest 2003;123:87-95.
ABSTRACT | FULL TEXT  

Dysautonomias: Clinical Disorders of the Autonomic Nervous System
Goldstein et al.
ANN INTERN MED 2002;137:753-763.
ABSTRACT | FULL TEXT  

Cardiac Sympathetic Dysautonomia in Chronic Orthostatic Intolerance Syndromes
Goldstein et al.
Circulation 2002;106:2358-2365.
ABSTRACT | FULL TEXT  

A Twin Study of Chronic Fatigue
Buchwald et al.
Psychosom. Med. 2001;63:936-943.
ABSTRACT | FULL TEXT  

Cardiovascular Responses of Women With Chronic Fatigue Syndrome to Stressful Cognitive Testing Before and After Strenuous Exercise
LaManca et al.
Psychosom. Med. 2001;63:756-764.
ABSTRACT | FULL TEXT  

Lower standing systolic blood pressure as a predictor of falls in the elderly: a community-based prospective study
Kario et al.
J Am Coll Cardiol 2001;38:246-252.
ABSTRACT | FULL TEXT  

Chronic Fatigue Syndrome
Natelson
JAMA 2001;285:2557-2559.
FULL TEXT  

Thirteen-Year Follow-Up of Children and Adolescents With Chronic Fatigue Syndrome
MD et al.
Pediatrics 2001;107:994-998.
ABSTRACT | FULL TEXT  

Orthostatic Hypotension and Chronic Fatigue Syndrome
Baschetti et al.
JAMA 2001;285:1441-1443.
FULL TEXT  

Fludrocortisone Acetate to Treat Neurally Mediated Hypotension in Chronic Fatigue Syndrome: A Randomized Controlled Trial
Rowe et al.
JAMA 2001;285:52-59.
ABSTRACT | FULL TEXT  

Results of Isoproterenol Tilt Table Testing in Monozygotic Twins Discordant for Chronic Fatigue Syndrome
Poole et al.
Arch Intern Med 2000;160:3461-3468.
ABSTRACT | FULL TEXT  

Exercise Capacity in Chronic Fatigue Syndrome
De Becker et al.
Arch Intern Med 2000;160:3270-3277.
ABSTRACT | FULL TEXT  

Vascular perturbations in the chronic orthostatic intolerance of the postural orthostatic tachycardia syndrome
Stewart and Weldon
J. Appl. Physiol. 2000;89:1505-1512.
ABSTRACT | FULL TEXT  

Cardiovascular Stress Responses and Their Relation to Symptoms in Gulf War Veterans With Fatiguing Illness
Peckerman et al.
Psychosom. Med. 2000;62:509-516.
ABSTRACT | FULL TEXT  

Blunted pressor and intramuscular metabolic responses to voluntary isometric exercise in multiple sclerosis
Ng et al.
J. Appl. Physiol. 2000;88:871-880.
ABSTRACT | FULL TEXT  

Functional Somatic Syndromes
Clemenger
ANN INTERN MED 2000;132:328-328.
FULL TEXT  

Functional Somatic Syndromes
Clemenger
ANN INTERN MED 2000;132:327-328.
FULL TEXT  

Extracts from "Clinical Evidence": Chronic fatigue syndrome
Reid et al.
BMJ 2000;320:292-296.
FULL TEXT  

New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification: Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge
Brignole et al.
Europace 2000;2:66-76.
ABSTRACT  

Acute Effects of Thirty Minutes of Light-Intensity, Intermittent Exercise on Patients With Chronic Fatigue Syndrome
Clapp et al.
ptjournal 1999;79:749-756.
ABSTRACT | FULL TEXT  

Chronic Fatigue Syndrome??
Perry; et al.
Pediatrics 1999;104:130-131.
FULL TEXT  

Low-Dose Hydrocortisone for Chronic Fatigue Syndrome
Baschetti et al.
JAMA 1999;281:1887-1889.
FULL TEXT  

Fibromyalgia Syndrome a Decade Later: What Have We Learned?
Goldenberg
Arch Intern Med 1999;159:777-785.
ABSTRACT | FULL TEXT  

Orthostatic Intolerance in Adolescent Chronic Fatigue Syndrome
Stewart et al.
Pediatrics 1999;103:116-121.
ABSTRACT | FULL TEXT  

Chronic Orthostatic Intolerance : Part of a Spectrum of Dysfunction in Orthostatic Cardiovascular Homeostasis?
Narkiewicz and Somers
Circulation 1998;98:2105-2107.
FULL TEXT  

Treatment for Chronic Fatigue Syndrome
Baschetti et al.
Arch Intern Med 1998;158:2266-2267.
FULL TEXT  

Amplified Amplitudes of Circadian Rhythms and Nighttime Hypotension in Patients with Chronic Fatigue Syndrome: Improvement by Inopamil But Not by Melatonin
van de Luit et al.
ANGIOLOGY 1998;49:903-908.
ABSTRACT  

The Nature of Chronic Fatigue
Streeten
JAMA 1998;280:1094-1095.
FULL TEXT  

Course and Outcome of Chronic Fatigue in Children and Adolescents
Krilov et al.
Pediatrics 1998;102:360-366.
ABSTRACT | FULL TEXT  

Seeking Answers to Chronic Fatigue Syndrome
Wallace et al.
JAMA 1998;279:1697-1698.
FULL TEXT  

Fatigue in primary Sjogren's syndrome
Barendregt et al.
Ann Rheum Dis 1998;57:291-295.
ABSTRACT | FULL TEXT  

A Preliminary Placebo-Controlled Crossover Trial of Fludrocortisone for Chronic Fatigue Syndrome
Peterson et al.
Arch Intern Med 1998;158:908-914.
ABSTRACT | FULL TEXT  

A 56-Year-Old Woman With Chronic Fatigue Syndrome
Komaroff
JAMA 1997;278:1179-1185.
ABSTRACT  

Chronic Fatigue Syndrome Should Not Be Diagnosed in Children
Plioplys
Pediatrics 1997;100:270-271.
FULL TEXT  

Chronic Fatigue Syndrome and Neurally Mediated Hypotension
Beard
JAMA 1996;275:359-359.
ABSTRACT  

Chronic Fatigue Syndrome and Neurally Mediated Hypotension
Baschetti
JAMA 1996;275:359-359.
ABSTRACT  

Chronic Fatigue Syndrome and Neurally Mediated Hypotension
Klonoff
JAMA 1996;275:359-360.
ABSTRACT  

Are Chronic Fatigue and Neurally Mediated Hypotension Related?
JWatch Psychiatry 1995;1995:4-4.
FULL TEXT