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Publicado el 13 de mayo de 2021 | http://doi.org/10.5867/medwave.2021.04.8194

Presión arterial y altitud: respuestas fisiológicas y manejo clínico

Blood pressure and high altitude: physiological response and clinical management

Morin Lang , Grzegorz Bilo, Sergio Caravita, Gianfranco Parati

Abstract

High altitude is an extreme environment that challenges human beings exposed because of work, recreational activities, or habitat. Exposure to hypobaric hypoxia results in physiological adaptations in response to the geography and the associated extreme environmental conditions. These acclimatization responses can be diverse and result from evolutionary changes and comorbidities. In this context, this review aims to identify the available evidence on the effects of high altitude on blood pressure—from the physiological to clinical aspects at rest and during exercise—and the underlying mechanisms and possible clinical implications of acute and chronic intermittent hypoxia.

No English version is available for this article.

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Autores

Morin Lang

Department of Rehabilitation Sciences and Human Movement, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile

morin.lang@uantof.cl.

Avenida Angamos 601, Antofagasta, Chile

https://orcid.org/0000-0002-8465-5471

Grzegorz Bilo

https://orcid.org/0000-0002-5104-9176

Sergio Caravita

https://orcid.org/0000-0002-3003-6499

Gianfranco Parati

https://orcid.org/0000-0001-9402-7439

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Historial

Citación Lang M, Bilo G, Caravita S, Parati G. Blood pressure and high altitude: physiological response and clinical management. Medwave 2021;21(04):e8194 doi: 10.5867/medwave.2021.04.8194

Envío 11/12/2020

Aceptación 19/04/2021

Publicación 13/05/2021

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Keywords

blood pressure, altitude, hypertension, hypoxia

Provenance and peer review

Con revisión por pares externa, por tres árbitros a doble ciego

Referencias

  1. Bärtsch P, Gibbs JS. Effect of altitude on the heart and the lungs. Circulation. 2007 Nov 6;116(19):2191-202. | CrossRef | PubMed
  2. Parati G, Agostoni P, Basnyat B, Bilo G, Brugger H, Coca A, et al. Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions: A joint statement by the European Society of Cardiology, the Council on Hypertension of the European Society of Cardiology, the European Society of Hypertension, the International Society of Mountain Medicine, the Italian Society of Hypertension and the Italian Society of Mountain Medicine. Eur Heart J. 2018 May 1;39(17):1546-1554. | CrossRef | PubMed
  3. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Press. 2018 Dec;27(6):314-340. | CrossRef | PubMed
  4. Keyes LE, Mather L, Duke C, Regmi N, Phelan B, Pant S, et al. Older age, chronic medical conditions and polypharmacy in Himalayan trekkers in Nepal: an epidemiologic survey and case series. J Travel Med. 2016 Aug 8;23(6):taw052. | CrossRef | PubMed
  5. Higgins JP, Tuttle T, Higgins JA. Altitude and the heart: is going high safe for your cardiac patient? Am Heart J. 2010 Jan;159(1):25-32. | CrossRef | PubMed
  6. Hansen J, Sander M. Sympathetic neural overactivity in healthy humans after prolonged exposure to hypobaric hypoxia. J Physiol. 2003 Feb 1;546(Pt 3):921-9. | CrossRef | PubMed
  7. Bilo G, Caldara G, Styczkiewicz K, Revera M, Lombardi C, Giglio A, et al. Effects of selective and nonselective beta-blockade on 24-h ambulatory blood pressure under hypobaric hypoxia at altitude. J Hypertens. 2011 Feb;29(2):380-7. | CrossRef | PubMed
  8. Wolfel EE, Selland MA, Mazzeo RS, Reeves JT. Systemic hypertension at 4,300 m is related to sympathoadrenal activity. J Appl Physiol (1985). 1994 Apr;76(4):1643-50. | CrossRef | PubMed
  9. Veglio M, Maule S, Cametti G, Cogo A, Lussiana L, Madrigale G, et al. The effects of exposure to moderate altitude on cardiovascular autonomic function in normal subjects. Clin Auton Res. 1999 Jun;9(3):123-7. | CrossRef | PubMed
  10. Parati G, Bilo G, Faini A, Bilo B, Revera M, Giuliano A, Lombardi C, et al. Changes in 24 h ambulatory blood pressure and effects of angiotensin II receptor blockade during acute and prolonged high-altitude exposure: a randomized clinical trial. Eur Heart J. 2014 Nov 21;35(44):3113-22. | CrossRef | PubMed
  11. Torlasco C, Bilo G, Giuliano A, Soranna D, Ravaro S, Oliverio G, et al. Effects of acute exposure to moderate altitude on blood pressure and sleep breathing patterns. Int J Cardiol. 2020 Feb 15;301:173-179. | CrossRef | PubMed
  12. Bilo G, Villafuerte FC, Faini A, Anza-Ramírez C, Revera M, Giuliano A, et al. Ambulatory blood pressure in untreated and treated hypertensive patients at high altitude: the High Altitude Cardiovascular Research-Andes study. Hypertension. 2015 Jun;65(6):1266-72. | CrossRef | PubMed
  13. Halliwill JR, Minson CT. Effect of hypoxia on arterial baroreflex control of heart rate and muscle sympathetic nerve activity in humans. J Appl Physiol (1985). 2002 Sep;93(3):857-64. | CrossRef | PubMed
  14. Bilo G, Revera M, Bussotti M, Bonacina D, Styczkiewicz K, Caldara G, et al. Effects of slow deep breathing at high altitude on oxygen saturation, pulmonary and systemic hemodynamics. PLoS One. 2012;7(11):e49074. | CrossRef | PubMed
  15. Siqués P, Brito J, Banegas JR, León-Velarde F, de la Cruz-Troca JJ, López V, et al. Blood pressure responses in young adults first exposed to high altitude for 12 months at 3550 m. High Alt Med Biol. 2009 Winter;10(4):329-35. | CrossRef | PubMed
  16. Aryal N, Weatherall M, Bhatta YK, Mann S. Blood Pressure and Hypertension in Adults Permanently Living at High Altitude: A Systematic Review and Meta-Analysis. High Alt Med Biol. 2016 Sep;17(3):185-193. | CrossRef | PubMed
  17. Bilo G, Acone L, Anza-Ramírez C, Macarlupú JL, Soranna D, Zambon A, et al. Office and Ambulatory Arterial Hypertension in Highlanders: HIGHCARE-ANDES Highlanders Study. Hypertension. 2020 Dec;76(6):1962-1970. | CrossRef | PubMed
  18. Cheong HI, Janocha AJ, Monocello LT, Garchar AC, Gebremedhin A, Erzurum SC, et al. Alternative hematological and vascular adaptive responses to high-altitude hypoxia in East African highlanders. Am J Physiol Lung Cell Mol Physiol. 2017 Feb 1;312(2):L172-L177. | CrossRef | PubMed
  19. Insalaco G, Romano S, Salvaggio A, Braghiroli A, Lanfranchi P, Patruno V, et al. Blood pressure and heart rate during periodic breathing while asleep at high altitude. J Appl Physiol (1985). 2000 Sep;89(3):947-55. | CrossRef | PubMed
  20. Naeije R. Physiological adaptation of the cardiovascular system to high altitude. Prog Cardiovasc Dis. 2010 May-Jun;52(6):456-66. | CrossRef | PubMed
  21. Caravita S, Faini A, Baratto C, Bilo G, Macarlupu JL, Lang M, et al. Upward Shift and Steepening of the Blood Pressure Response to Exercise in Hypertensive Subjects at High Altitude. J Am Heart Assoc. 2018 Jun 9;7(12):e008506. | CrossRef | PubMed
  22. Salvi P, Revera M, Faini A, Giuliano A, Gregorini F, Agostoni P, et al. Changes in subendocardial viability ratio with acute high-altitude exposure and protective role of acetazolamide. Hypertension. 2013 Apr;61(4):793-9. | CrossRef | PubMed
  23. Caravita S, Faini A, Bilo G, Revera M, Giuliano A, Gregorini F, et al. Ischemic changes in exercise ECG in a hypertensive subject acutely exposed to high altitude. Possible role of a high-altitude induced imbalance in myocardial oxygen supply-demand. Int J Cardiol. 2014 Feb 15;171(3):e100-2. | CrossRef | PubMed
  24. Wyss CA, Koepfli P, Fretz G, Seebauer M, Schirlo C, Kaufmann PA. Influence of altitude exposure on coronary flow reserve. Circulation. 2003 Sep 9;108(10):1202-7. | CrossRef | PubMed
  25. Lang M, Faini A, Caravita S, Bilo G, Anza-Ramìrez C, Villafuerte FC, et al. Blood pressure response to six-minute walk test in hypertensive subjects exposed to high altitude: effects of antihypertensive combination treatment. Int J Cardiol. 2016 Sep 15;219:27-32. | CrossRef | PubMed
  26. Caravita S, Faini A, Bilo G, Villafuerte FC, Macarlupu JL, Lang M. Blood Pressure Response to Exercise in Hypertensive Subjects Exposed to High Altitude and Treatment Effects. J Am Coll Cardiol. 2015 Dec 22;66(24):2806-2807. | CrossRef | PubMed
  27. Valentini M, Revera M, Bilo G, Caldara G, Savia G, Styczkiewicz K, et al. Effects of beta-blockade on exercise performance at high altitude: a randomized, placebo-controlled trial comparing the efficacy of nebivolol versus carvedilol in healthy subjects. Cardiovasc Ther. 2012 Aug;30(4):240-8. | CrossRef | PubMed
  28. SONAMI SNdMdC. Mapa Minero de Chile. [On line] | Link
  29. MINSAL.(2013). Guía Técnica sobre Exposición Ocupacional a Hipobaria Intermitente Crónica por Gran Altitud. [On line] | Link
  30. Farias JG, Jimenez D, Osorio J, Zepeda AB, Figueroa CA, Pulgar VM. Acclimatization to chronic intermittent hypoxia in mine workers: a challenge to mountain medicine in Chile. Biol Res. 2013;46(1):59-67. | CrossRef | PubMed
  31. Richalet JP, Donoso MV, Jiménez D, Antezana AM, Hudson C, Cortès G, et al. Chilean miners commuting from sea level to 4500 m: a prospective study. High Alt Med Biol. 2002 Summer;3(2):159-66. | CrossRef | PubMed
  32. Brito J, Siqués P, León-Velarde F, De La Cruz JJ, López V, Herruzo R. Chronic intermittent hypoxia at high altitude exposure for over 12 years: assessment of hematological, cardiovascular, and renal effects. High Alt Med Biol. 2007 Fall;8(3):236-44. | CrossRef | PubMed
  33. Brito J, Siques P, López R, Romero R, León-Velarde F, Flores K, et al. Long-Term Intermittent Work at High Altitude: Right Heart Functional and Morphological Status and Associated Cardiometabolic Factors. Front Physiol. 2018 Mar 22;9:248. | CrossRef | PubMed
  34. Wu TY, Ding SQ, Liu JL, Yu MT, Jia JH, Chai ZC, et al. Who should not go high: chronic disease and work at altitude during construction of the Qinghai-Tibet railroad. High Alt Med Biol. 2007 Summer;8(2):88-107. | CrossRef | PubMed
  35. Lawes CM, Vander Hoorn S, Rodgers A; International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet. 2008 May 3;371(9623):1513-8. | CrossRef | PubMed
  36. Social SSdS. (2018). Estudio de los efectos de la exposición intermitente a gran altitud sobre la salud de trabajadores de faenas mineras. [On line] | Link
  37. Parati G, Ochoa JE, Torlasco C, Salvi P, Lombardi C, Bilo G. Aging, High Altitude, and Blood Pressure: A Complex Relationship. High Alt Med Biol. 2015 Jun;16(2):97-109. | CrossRef | PubMed
  38. Somers VK, Mark AL, Abboud FM. Potentiation of sympathetic nerve responses to hypoxia in borderline hypertensive subjects. Hypertension. 1988 Jun;11(6 Pt2):608-12. | CrossRef | PubMed
  39. Krapf R, Jaeger P, Hulter HN. Chronic respiratory alkalosis induces renal PTH-resistance, hyperphosphatemia and hypocalcemia in humans. Kidney Int. 1992 Sep;42(3):727-34. | CrossRef | PubMed
  40. Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, et al. Further Evolution of the ACC/AHA Clinical Practice Guideline Recommendation Classification System: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2016 Apr 5;133(14):1426-8. | CrossRef | PubMed
  41. Parati G, Revera M, Giuliano A, Faini A, Bilo G, Gregorini F, et al. Effects of acetazolamide on central blood pressure, peripheral blood pressure, and arterial distensibility at acute high altitude exposure. Eur Heart J. 2013 Mar;34(10):759-66. | CrossRef | PubMed