Long- and Short-Term Blood Pressure and Rr-Interval Variability and Psychosomatic Distress in Chronic Fatigue Syndrome

Abstract

1. Chronic low blood pressure has been associated with fatigue and low mood. However, in the chronic fatigue syndrome (CFS) the blood pressure (BP) and heart rate profile and their variabilities have not been characterized as yet. 2. We performed office and 24 h ambulatory BP recordings in 38 subjects (age, 34.8 +/- 8.0 years) who fulfilled the Holmes criteria for CFS and in 38 healthy control subjects (age 35.6 +/- 10.5 years), as well as short-term beat-to-beat BP and RR-interval recordings for 10 min in supine and standing position, and calculated spectral indices. 3. In CFS office (123 +/- 19/70 +/- 12 mmHg) as well as 24-h, day- and night-time blood pressure values (116 +/- 11.1/71 +/- 11.1, 121 +/- 9.2/77 +/- 8.0 and 110 +/- 10.5/65 +/- 9.2 mmHg respectively) were within reference limits. 4. Heart rate was consistently higher (P < 0.01) in CFS patients, based on both office (77 +/- 12 compared with 68 +/- 12 beats min-1) and 24 h ambulatory recordings (77 +/- 12 compared with 67 +/- 15 beats min-1). 5. In supine position, spectral indices of BP variability (total, low-frequency and high-frequency variances) were all significantly (P < 0.01) lower in CFS. In standing position the differences disappeared. Analysis of RR-interval variability could not detect major alterations in autonomic function in CFS.

Autonomic function in patients with chronic fatigue syndrome

“…Freeman et al [9] also could not demonstrate orthostatic hypotension during active standing in CFS patients. This is in agreement with another study in which active standing for 30 minutes did not elicit orthostatic hypotension in unselected CFS patients [26]. However, using a prolonged tilt [pre]syncope) to head-up tilt without isoproterenol administration occurred in 25% [9], 40% [11], 71% [7], or 100% [8] of the CFS patients.…”

“…The heart rate response during standing tended to be lower in our CFS group, which was not found in other studies [9,26]. The I-E difference was also slightly decreased, which was also found by Freeman et al [9].…”

“…Some could demonstrate a decreased heart rate variability in rest or during paced breathing, using spectral analysis of RR intervals [23][24][25], reflecting a possible decreased vagal tone. Others could not find a difference in heart rate variability [12,26]. Differences in the used study protocol and in the selection of patients and controls might account for the discrepancies between the different studies.…”

Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome

“…This is in agreement with some [4,9,34,40] but not all [8,41] reports on autonomic cardiovascular regulation in CFS. An increased supine heart rate seems to be consistent with the findings of sympathetic predominance in CFS patients at rest, as has also been estimated from spectral indices of heart rate and blood pressure variability [6,8].…”

“…Some studies reported subtle changes in "sympathetic-parasympathetic balance" [4][5][6][7][8][9], indicating alterations in cardiovascular autonomic control in response to orthostatic stress in CFS patients. As a clinical CAR 014 s Abstract Background Data on the prevalence of orthostatic intolerance (OI) in patients with chronic fatigue syndrome (CFS) are limited and controversial.…”