Timmers, H J L M, Wieling, W, Soetekouw, P M M B et al. · Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2002 · DOI
This study looked at whether ME/CFS patients have problems with blood pressure and heart rate control when standing up or tilting upright. Researchers tested 36 ME/CFS patients and 36 healthy people by tilting them upright for 40 minutes while measuring heart function and stress hormones. About 28% of ME/CFS patients had abnormal responses (like fainting symptoms or rapid heart rate), compared to 17% of healthy controls, though this difference was not statistically significant.
Orthostatic intolerance is commonly reported by ME/CFS patients and significantly impacts daily functioning. This study provides objective physiological evidence of abnormal cardiovascular responses in a subset of ME/CFS patients, helping validate patient-reported symptoms and suggesting deconditioning as a potential contributing mechanism worthy of further investigation.
This study does not prove that orthostatic intolerance is a primary cause of ME/CFS, only that it occurs in some patients. The cross-sectional design cannot establish causality or determine whether cardiovascular abnormalities precede CFS onset or result from it. The lack of statistical significance in the primary comparison between CFS and controls suggests orthostatic intolerance may not be a universal feature of ME/CFS.
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
Timmers, H J L M, Wieling, W, Soetekouw, P M M B, Bleijenberg, G, Van Der Meer, J W M, & Lenders, J W M (2002). Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome.. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. https://doi.org/10.1007/s10286-002-0014-1
BibTeX
@article{mecfsatlas-timmers-2002-hemodynamic-neurohumoral,
author = {Timmers, H J L M and Wieling, W and Soetekouw, P M M B and Bleijenberg, G and Van Der Meer, J W M and Lenders, J W M},
title = {Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome.},
journal = {Clinical autonomic research : official journal of the Clinical Autonomic Research Society},
year = {2002},
doi = {10.1007/s10286-002-0014-1},
note = {PubMed: 12357281},
url = {https://www.mecfsatlas.com/evidence/timmers-2002-hemodynamic-neurohumoral},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/timmers-2002-hemodynamic-neurohumoral
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