Hopkins links blood pressure to chronic fatigue illness Hopkins presents theory to explain syndrome of mysterious weariness

September 27, 1995|By Jonathan Bor | Jonathan Bor,SUN STAFF

Chronic fatigue syndrome is often the result of a common blood-pressure abnormality -- not a psychiatric problem or a tendency to fake symptoms, doctors at the Johns Hopkins School of Medicine said yesterday.

Physicians who studied 23 fatigued adults said all but one suffered from fainting spells and periods of light-headedness -- the same condition that strikes many people after standing on their feet for long periods on a hot day.

Even more intriguing, most felt more alert and energetic when they took medications and ate foods that raised blood pressure.

"This provides some hope to patients that symptoms of chronic fatigue syndrome can be improved and in some cases markedly improved with treatment," said Dr. Hugh Calkins, director of Hopkins' electrophysiology laboratory and one of the study's leaders.

One happy example is Katie Lucas, 34, who quit her job as a financial planner four years ago when she had trouble getting out of bed, balancing her checkbook or doing simple calculations.

In a fruitless search for a cure, she went to 30 doctors and tried vitamin B-12 injections, anti-viral drugs, allergy treatments and other medications. Finally, after enrolling in the Hopkins experiment, she was diagnosed with the fainting condition known as neurally mediated hypotension and placed on blood-pressure drugs and a higher-salt diet.

She didn't feel better right away. Doctors first spent weeks tinkering with the medication to find the right dosage.

"Now, I'm able to go to the store, cook, go shopping at the mall, and I can drive from Richmond to Baltimore -- things I couldn't do before," said Ms. Lucas, who has returned to school and hopes to earn a degree in public health. "This is vindicating and it is validating."

Doctors cautioned that the treatments can't be considered a success until they are subjected to a larger study that pits the drugs against a placebo. That would help determine if the initial success had a psychological basis -- that patients felt better because they expected the drugs to work.

The study was also conducted by Dr. Peter Rowe, Dr. Jean Kan and Dr. Issam Bou-Holaigah, all of Hopkins.

The experiment, reported in today's Journal of the American Medical Association, confirms an earlier Hopkins study of teen-agers who felt fatigued but didn't necessarily meet the definition of chronic fatigue syndrome.

Participants in the new study were all adults meeting the definition set by the federal health agencies: They suffered from prolonged periods of fatigue that were not caused by exertion and did not improve with rest. Patients also suffered from combinations of short-term memory loss, sore throat, muscle and joint pain, headaches, unrefreshing sleep and malaise.

In the study, 23 people with chronic fatigue were placed horizontally on a tilt table, then rotated to a near-standing position. All but one felt nauseous or lightheaded -- often a half-hour or so into the experiment. Their blood pressure dropped. Some passed out. Many were tired for days.

The tilt-table test seemed to confirm a link between chronic fatigue syndrome and neurally mediated hypotension. Under more natural conditions, people with the blood-pressure abnormality faint or feel woozy after exercise, long periods of standing or exposure to warm temperatures.

The problem stems from a miscommunication between the brain and the heart: Just when the heart needs to pump faster and more vigorously to keep blood from pooling in the feet, it pumps lethargically.

Nine patients said they recovered almost all their energy after taking medications and consuming more salt. Seven said they felt a substantial improvement.

Several hundred thousand Americans -- up to three per 1,000 people -- are thought to suffer from chronic fatigue syndrome. The blood-pressure abnormality is much more common, and doctors said they had no idea why it triggers chronic fatigue in some patients but not in others.

Dr. Robin McKenzie, a chronic fatigue researcher at the National Institutes of Health, said the Hopkins findings are intriguing.

"We are interested in that theory -- it's a new one -- but what we clearly need is a double-blinded study," said Dr. McKenzie, who along with other researchers at the National Institutes on Allergies and Infectious Diseases is planning to collaborate with the Hopkins team on such a study.

In a double-blind experiment, neither the researchers nor the subjects know whether a patient is taking placebos or the experimental drug.

Several years ago, NIH scientists discounted a popular theory that the Epstein-Barr virus caused chronic fatigue. Now, they are entertaining the possibility that not one but various viruses could set off hormonal changes that, in turn, could cause the abnormal blood-pressure reflex.

This could be a more complete explanation of chronic fatigue syndrome, but Dr. McKenzie noted the theory has not been confirmed.

Fatigue

People wanting information about chronic fatigue syndrome, neurally mediated hypotension or a new trial planned for the Baltimore-Washington area can call Johns Hopkins at 410-821-7253. Callers can also request a copy of the study that appears in today's Journal of the American Medical Association.

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