Poole, J, Herrell, R, Ashton, S et al. · Archives of internal medicine · 2000 · DOI
This study tested whether a condition called neurally mediated hypotension (a sudden drop in blood pressure) might be causing ME/CFS. Researchers compared identical twins where one had ME/CFS and one was healthy, using a tilt table test to measure blood pressure responses. They found that healthy twins and twins with ME/CFS had similar rates of this blood pressure problem, suggesting it is probably not a main cause of ME/CFS.
This study challenges the hypothesis that neurally mediated hypotension is a primary driver of ME/CFS, an idea that had gained clinical traction in the 1990s. By using genetically identical twins and rigorous matching, it provides strong evidence that factors other than NMH abnormalities must underlie ME/CFS pathogenesis, redirecting research focus toward other biological mechanisms.
This study does not prove that NMH never occurs in ME/CFS patients or that it cannot contribute to symptoms in a subset of patients. The finding of equal NMH prevalence in both groups does not rule out other cardiovascular or autonomic nervous system abnormalities in ME/CFS. Additionally, the study cannot explain why CFS-affected twins reported more severe symptoms during testing despite similar objective test results.
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
Poole, J, Herrell, R, Ashton, S, Goldberg, J, & Buchwald, D (2000). Results of isoproterenol tilt table testing in monozygotic twins discordant for chronic fatigue syndrome.. Archives of internal medicine. https://doi.org/10.1001/archinte.160.22.3461
BibTeX
@article{mecfsatlas-poole-2000-results-isoproterenol,
author = {Poole, J and Herrell, R and Ashton, S and Goldberg, J and Buchwald, D},
title = {Results of isoproterenol tilt table testing in monozygotic twins discordant for chronic fatigue syndrome.},
journal = {Archives of internal medicine},
year = {2000},
doi = {10.1001/archinte.160.22.3461},
note = {PubMed: 11112240},
url = {https://www.mecfsatlas.com/evidence/poole-2000-results-isoproterenol},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/poole-2000-results-isoproterenol
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