title: Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: a randomized controlled trial.
abstract: BACKGROUND
  Patients with chronic fatigue syndrome (CFS) are more likely than healthy persons to develop neurally mediated hypotension (NMH) in response to prolonged orthostatic stress.
  
  
  OBJECTIVE
  To examine the efficacy of fludrocortisone acetate as monotherapy for adults with both CFS and NMH.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled trial conducted between March 1996 and February 1999.
  
  
  METHODS
  Two tertiary referral centers in the United States.
  
  
  METHODS
  One hundred individuals aged 18 to 50 years who satisfied Centers for Disease Control and Prevention criteria for CFS and had NMH provoked during a 2-stage tilt-table test. Eighty-three subjects had adequate outcome data to assess efficacy.
  
  
  METHODS
  Subjects were randomly assigned to receive fludrocortisone acetate, titrated to 0.1 mg/d (n = 50) or matching placebo (n = 50) for 9 weeks, followed by 2 weeks of observation after discontinuation of therapy.
  
  
  METHODS
  Proportion of subjects in each group with at least a 15-point improvement on a 100-point global wellness scale.
  
  
  RESULTS
  Baseline demographic and illness characteristics between the groups were similar; CFS had been present for at least 3 years in 71%. Using an intention-to-treat analysis, 7 subjects (14%) treated with fludrocortisone experienced at least a 15-point improvement in their wellness scores compared with 5 (10%) among placebo recipients (P =.76). No differences were observed in several other symptom scores or in the proportion with normal follow-up tilt test results at the end of the treatment period.
  
  
  CONCLUSIONS
  In our study of adults with CFS, fludrocortisone as monotherapy for NMH was no more efficacious than placebo for amelioration of symptoms. Failure to identify symptomatic improvement with fludrocortisone does not disprove the hypothesis that NMH could be contributing to some of the symptoms of CFS. Further studies are needed to determine whether other medications or combination therapy are more effective in treating orthostatic intolerance in patients with CFS.
authors.affiliation: Departments of Pediatrics and Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Rowe
authors.forename: H
authors.initials: H
authors.lastname: Calkins
authors.forename: K
authors.initials: K
authors.lastname: DeBusk
authors.forename: R
authors.initials: R
authors.lastname: McKenzie
authors.forename: R
authors.initials: R
authors.lastname: Anand
authors.forename: G
authors.initials: G
authors.lastname: Sharma
authors.forename: B A
authors.initials: BA
authors.lastname: Cuccherini
authors.forename: N
authors.initials: N
authors.lastname: Soto
authors.forename: P
authors.initials: P
authors.lastname: Hohman
authors.forename: S
authors.initials: S
authors.lastname: Snader
authors.forename: K E
authors.initials: KE
authors.lastname: Lucas
authors.forename: M
authors.initials: M
authors.lastname: Wolff
authors.forename: S E
authors.initials: SE
authors.lastname: Straus
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D015673:Fatigue Syndrome, Chronic / Q000150:complications*; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D018667:Tilt-Table Test; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D005438:Fludrocortisone