Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: Dr Rowe and colleagues1 studied the effectiveness of fludrocortisone acetate in relieving symptoms among patients with CFS and NMH. No differences were found between the placebo and fludrocortisone groups in either symptoms of CFS or NMH.
The authors reported that 66% of their study patients with CFS developed NMH, postural tachycardia syndrome, or both in response to a 2-stage tilt-table test. They noted that the reported prevalence of NMH in other studies has varied widely, from 22% to 96%. The authors speculated on a variety of factors that might account for the variation in reported prevalence and response to treatment. One potential source of unexplained variation in symptoms and hemodynamic changes in CFS that has not been reported either by Rowe et al or previous investigators is tobacco use.
Jay SJ. Orthostatic Hypotension and Chronic Fatigue Syndrome. JAMA. 2001;285(11):1441-1443. doi:10.1001/jama.285.11.1441