Streeten, D H, Anderson, G H · Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 1998 · DOI
This study looked at whether problems with blood pressure regulation—specifically a delayed drop in blood pressure when standing up—might explain why some people with chronic fatigue syndrome feel so exhausted. Researchers surveyed 431 patients with various neurological and hormonal disorders and found that fatigue was very common in people with delayed blood pressure drops and low cortisol levels (70-83%), but much less common in people with other conditions like multiple system atrophy (7-33%). This suggests a possible connection between blood pressure regulation problems and severe fatigue.
This research is significant for ME/CFS because it identifies delayed orthostatic hypotension and hypocortisolism as potential physiological mechanisms underlying severe fatigue—two abnormalities that have been independently reported in ME/CFS populations. Understanding which autonomic and endocrine dysfunctions correlate with fatigue could help guide diagnostic testing and targeted treatment development for ME/CFS patients.
This study does not prove that orthostatic hypotension or low cortisol *causes* CFS, only that these conditions are associated with high fatigue rates. The cross-sectional design means temporal relationships cannot be established. Additionally, the study examines fatigue as a general symptom without assessing post-exertional malaise or other ME/CFS-specific diagnostic criteria, limiting direct conclusions about CFS pathogenesis.
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
Streeten, D H & Anderson, G H (1998). The role of delayed orthostatic hypotension in the pathogenesis of chronic fatigue.. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. https://doi.org/10.1007/BF02267822
BibTeX
@article{mecfsatlas-streeten-1998-role-delayed,
author = {Streeten, D H and Anderson, G H},
title = {The role of delayed orthostatic hypotension in the pathogenesis of chronic fatigue.},
journal = {Clinical autonomic research : official journal of the Clinical Autonomic Research Society},
year = {1998},
doi = {10.1007/BF02267822},
note = {PubMed: 9613802},
url = {https://www.mecfsatlas.com/evidence/streeten-1998-role-delayed},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/streeten-1998-role-delayed
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