Wilke, W S, Fouad-Tarazi, F M, Cash, J M et al. · Cleveland Clinic journal of medicine · 1998 · DOI
Some ME/CFS patients experience a problem where their blood pressure drops abnormally when they stand up, a condition called neurally mediated hypotension. This review examines research showing that this blood pressure response may be linked to ME/CFS symptoms. Understanding this connection could help explain why some patients feel worse with certain activities and may guide treatment options.
Identifying neurally mediated hypotension as a potential pathophysiological mechanism in ME/CFS provides a testable explanation for symptom exacerbation with postural changes and physical activity. This mechanistic insight offers a framework for targeted clinical interventions and helps validate patient experiences of orthostatic intolerance, moving beyond dismissive attitudes toward physiological investigation.
This review does not establish that neurally mediated hypotension causes ME/CFS or that it is present in all patients with the condition. The article cannot determine causality from the reviewed studies, and it does not prove the mechanism explains all or even most ME/CFS symptoms. The speculative extension to fibromyalgia lacks sufficient evidence.
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 →
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