Bou-Holaigah, I, Rowe, P C, Kan, J et al. · JAMA · 1995
Researchers tested whether ME/CFS patients have an abnormal blood pressure response when standing upright. They tilted 23 ME/CFS patients and 14 healthy controls on a special table and monitored their vital signs. Nearly all ME/CFS patients showed an abnormal response, and about 9 patients felt much better after taking medications to treat low blood pressure.
This research identified a potential physiological mechanism underlying ME/CFS symptoms—abnormal blood pressure regulation—and demonstrated that a subset of patients may benefit from targeted cardiovascular treatment. This offers hope for symptomatic improvement and suggests ME/CFS may involve measurable physiological dysfunction rather than being purely psychiatric.
This study does not prove that neurally mediated hypotension causes ME/CFS in all patients or that it is the primary mechanism of the disease. The improvement in 9 patients does not establish that this treatment will work for the majority of ME/CFS patients, as the study lacked a control group receiving placebo and used no blinding. Correlation between abnormal tilt response and ME/CFS does not exclude other concurrent or alternative pathophysiological mechanisms.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Bou-Holaigah, I, Rowe, P C, Kan, J, & Calkins, H (1995). The relationship between neurally mediated hypotension and the chronic fatigue syndrome.. JAMA. https://pubmed.ncbi.nlm.nih.gov/7674527/
BibTeX
@article{mecfsatlas-bou-holaigah-1995-relationship-between,
author = {Bou-Holaigah, I and Rowe, P C and Kan, J and Calkins, H},
title = {The relationship between neurally mediated hypotension and the chronic fatigue syndrome.},
journal = {JAMA},
year = {1995},
note = {PubMed: 7674527},
url = {https://www.mecfsatlas.com/evidence/bou-holaigah-1995-relationship-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/bou-holaigah-1995-relationship-between
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