ME and CFS Medical Abnormalities – Circulation


Following is a list of articles about blood pressure, heart rate and heart rate variability in ME and CFS

Links to the more than 1,000 peer-reviewed journal articles are listed on the M.E. and CFS Medical Abnormalities page of this website.


Boissoneault J, Letzen J, Robinson M, Staud R. Cerebral blood flow and heart rate variability predict fatigue severity in patients with chronic fatigue syndrome. Brain Imaging Behav. 2018 May 31. PMID: 29855991

In this arterial spin labeling (ASL) MRI study, the authors examined variability in cerebral blood flow (CBFV) and heart rate (HRV) in 28 women: 14 with CFS and 14 healthy controls. Greater CBFV and more HRV power were both associated with lower fatigue symptom severity in individuals with CFS.


Bozzini S, Albergati A, Capelli E, Lorusso L, Gazzaruso C, Pelissero G, Falcone C. Cardiovascular characteristics of chronic fatigue syndrome. Biomed Rep. 2018 Jan;8(1):26-30. PMID: 29399336

The aim of the current study was to describe cardiological and clinical characteristics of Italian patients with CFS. A significant association between the disease and low levels of blood pressure was identified. Other pilot studies revealed a higher prevalence of hypotension and orthostatic intolerance in patients with CFS. Furthermore, many of the CFS symptoms, including fatigue, vertigo, decreased concentration, tremors and nausea, may be explained by hypotension.


Malfliet A, Pas R, Brouns R, De Win J, Hatem SM, Meeus M, Ickmans K, van Hooff RJ, Nijs J. Cerebral Blood Flow and Heart Rate Variability in Chronic Fatigue Syndrome: A Randomized Cross-Over Study. Pain Physician. 2018 Jan;21(1):E13-E24. PMID: 29357332

These results seem to refute the previously suggested alterations of cerebral blood flow/heart rate variability in CFS patients. These cardiovascular parameters appear not to explain pain before, during, and following exercise.


Wyller VB, Fagermoen E, Sulheim D, Winger A, Skovlund E, Saul JP. Orthostatic responses in adolescent chronic fatigue syndrome: contributions from expectancies as well as gravity. Biopsychosoc Med. 2014 Sep 15;8:22. PMID: 25237387

At supine rest, CFS patients had significantly higher heart rate, diastolic blood pressure, and mean arterial blood pressure, and lower stroke index and heart rate variability (HRV) indices.


Gao J, Gurbaxani BM, Hu J, Heilman KJ, Emanuele Ii VA, Lewis GF, Davila M, Unger ER, Lin JM. Multiscale analysis of heart rate variability in non-stationary environments. Front Physiol. 2013 May 30;4:119. PMID: 23755016

Multiscale analyses suggested that there are notable differences in heart rate variability between CFS patients and matched controls before a social stress test, but that these differences seemed to diminish during the test.


Meeus M, Goubert D, De Backer F, Struyf F, Hermans L, Coppieters I, De Wandele I, Da Silva H, Calders P. Heart rate variability in patients with fibromyalgia and patients with chronic fatigue syndrome: A systematic review. Semin Arthritis Rheum. 2013 Oct;43(2):279-87. PMID: 23838093

Fibromyalgia patients show more heart rate variability aberrances and indices of increased sympathetic activity. Increased sympathetic activity is only present in CFS patients at night.


Hurum H, Sulheim D, Thaulow E, Wyller VB. Elevated nocturnal blood pressure and heart rate in adolescent chronic fatigue syndrome. Acta Paediatr. 2011 Feb;100(2):289-92. PMID: 21059182

In adolescent CFS patients at night, heart rate, arterial blood pressure and diastolic blood pressure were higher than normal; during daytime, heart rate was higher than normal but both blood pressure readings were normal.


Burton AR, Rahman K, Kadota Y, Lloyd A, Vollmer-Conna U. Reduced heart rate variability predicts poor sleep quality in a case-control study of chronic fatigue syndrome. Exp Brain Res. 2010 Jul;204(1):71-8. PMID: 20502886

This study identified significant reductions in vagal modulation of heart rate during sleep in CFS. Low heart rate variance strongly predicted sleep quality-suggesting a pervasive state of nocturnal sympathetic hypervigilance in CFS.


Newton JL, Sheth A, Shin J, Pairman J, Wilton K, Burt JA, Jones DE. Lower ambulatory blood pressure in chronic fatigue syndrome. Psychosom Med. 2009 Apr;71(3):361-5. PMID: 19297309

CFS patients have lower blood pressure and abnormal blood pressure regulation.


Newton JL, Okonkwo O, Sutcliffe K, Seth A, Shin J, Jones DE. Symptoms of autonomic dysfunction in chronic fatigue syndrome. QJM. 2007 Aug;100(8):519-26. PMID: 17617647

Symptoms of autonomic dysfunction were associated with CFS and correlated with the severity of the fatigue.


Boneva RS, Decker MJ, Maloney EM, Lin JM, Jones JF, Helgason HG, Heim CM, Rye DB, Reeves WC. Higher heart rate and reduced heart rate variability persist during sleep in chronic fatigue syndrome: a population-based study. Auton Neurosci. 2007 Dec 30;137(1-2):94-101. PMID: 17851136

The presence of increased heart rate and reduced heart rate variability in CFS during sleep coupled with higher norepinephrine levels and lower plasma aldosterone suggest a state of sympathetic ANS predominance and neuroendocrine alterations.


Winkler AS, Blair D, Marsden JT, Peters TJ, Wessely S, Cleare AJ. Autonomic function and serum erythropoietin levels in chronic fatigue syndrome. J Psychosom Res. 2004 Feb;56(2):179-83. PMID:15016575

Autonomic testing in patients with chronic fatigue syndrome yielded a significantly greater increase in heart rate together with a more pronounced systolic blood pressure fall on standing compared to healthy individuals. Heart rate beat-to-beat variation on deep breathing and responses to the Valsalva manoeuvre were normal. Serum erythropoietin levels were within reference range.


Vanness JM, Snell CR, Strayer DR, Dempsey L 4th, Stevens SR. Subclassifying chronic fatigue syndrome through exercise testing. Med Sci Sports Exerc. 2003 Jun;35(6):908-13. PMID: 12783037

On a graded exercise test, significant differences were found between impairment levels of CFS patients for percentage of predicted [OV0312]O(2) and peak heart rate.


Naschitz JE, Sabo E, Naschitz S, Rosner I, Rozenbaum M, Fields M, Isseroff H, Priselac RM, Gaitini L, Eldar S, Zukerman E, Yeshurun D. Hemodynamics instability score in chronic fatigue syndrome and in non-chronic fatigue syndrome. Semin Arthritis Rheum. 2002 Dec;32(3):141-8. PMID: 12528078

The cardiovascular reactivity in patients with CFS has certain features in common with the reactivity in patients with recurrent syncope or non-CFS chronic fatigue, such as the frequent occurrence of vasodepressor reaction, cardioinhibitory reaction, and postural tachycardia syndrome. Apart from to these shared responses, the large majority of CFS patients exhibit a particular abnormality which is characterized by hemodynamic instability score values >-0.98, lending objective criteria to the assessment of CFS.


Naschitz JE, Sabo E, Naschitz S, Rosner I, Rozenbaum M, Priselac RM, Gaitini L, Zukerman E, Yeshurun D. Fractal analysis and recurrence quantification analysis of heart rate and pulse transit time for diagnosing chronic fatigue syndrome. Clin Auton Res. 2002 Aug;12(4):264-72. PMID: 12357280

This study aimed to develop a method to distinguish between the cardiovascular reactivity in chronic fatigue syndrome (CFS) and other patient populations. The authors found that the best cut-off distinguishing CFS patients from others was the Fractal & Recurrence Analysis-based Score, which has potential as a diagnostic.


Farquhar WB, Hunt BE, Taylor JA, Darling SE, Freeman R. Blood volume and its relation to peak O(2) consumption and physical activity in patients with chronic fatigue. Am J Physiol Heart Circ Physiol. 2002 Jan;282(1):H66-71. PMID: 11748048

Individuals with CFS have a significantly lower peak oxygen consumption and an insignificant trend toward lower blood volume compared with controls. These two factors are highly related to one another.


Duprez DA, De Buyzere ML, Drieghe B, Vanhaverbeke F, Taes Y, Michielsen W, Clement DL. Long- and short-term blood pressure and RR-interval variability and psychosomatic distress in chronic fatigue syndrome. Clin Sci (Lond). 1998 Jan;94(1):57-63. PMID: 9505867

CFS patients had higher heart rates and (in supine position) lower spectral indices of blood pressure variability than normal people.


Montague TJ, Marrie TJ, Klassen GA, Bewick DJ, Horacek BM. Cardiac function at rest and with exercise in the chronic fatigue syndrome. Chest. 1989 Apr;95(4):779-84. PMID: 2924607

Patients with CFS have normal resting cardiac function but a markedly abbreviated exercise capacity characterized by slow acceleration of heart rate and fatigue of exercising muscles long before peak heart rate is achieved.


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