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

Gianfranco Parati, Piergiuseppe Agostoni, Buddha Basnyat, Grzegorz Bilo, Hermann Brugger, Antonio Coca, Luigi Festi, Guido Giardini, Alessandra Lironcurti, Andrew M Luks, Marco Maggiorini, Pietro A Modesti, Erik R Swenson, Bryan Williams, Peter Bärtsch, Camilla Torlasco, Gianfranco Parati, Piergiuseppe Agostoni, Buddha Basnyat, Grzegorz Bilo, Hermann Brugger, Antonio Coca, Luigi Festi, Guido Giardini, Alessandra Lironcurti, Andrew M Luks, Marco Maggiorini, Pietro A Modesti, Erik R Swenson, Bryan Williams, Peter Bärtsch, Camilla Torlasco

Abstract

Take home figureAdapted from Bärtsch and Gibbs2 Physiological response to hypoxia. Life-sustaining oxygen delivery, in spite of a reduction in the partial pressure of inhaled oxygen between 25% and 60% (respectively at 2500 m and 8000 m), is ensured by an increase in pulmonary ventilation, an increase in cardiac output by increasing heart rate, changes in vascular tone, as well as an increase in haemoglobin concentration. BP, blood pressure; HR, heart rate; PaCO2, partial pressure of arterial carbon dioxide.

Figures

Take home figure
Take home figure
Adapted from Bärtsch and Gibbs Physiological response to hypoxia. Life-sustaining oxygen delivery, in spite of a reduction in the partial pressure of inhaled oxygen between 25% and 60% (respectively at 2500 m and 8000 m), is ensured by an increase in pulmonary ventilation, an increase in cardiac output by increasing heart rate, changes in vascular tone, as well as an increase in haemoglobin concentration. BP, blood pressure; HR, heart rate; PaCO2, partial pressure of arterial carbon dioxide.
Figure 1
Figure 1
Altitude classification (Imray et al.1S) (left column); corresponding barometric pressure and fraction in inspired oxygen for different simulated altitudes in a laboratory setting, according to the 1976 US standard Atmosphere by NASA.5S (central two columns); relationship between altitude2S and environmental characteristics (temperature, humidity, and solar radiation) (box on the right-hand side). We used the 1976 US standard atmosphere model by NASA to estimate barometric pressure at a given altitude, because the former is a function not only of altitude but also of latitude. For similar altitudes, barometric pressure (and consequently also partial pressure of arterial oxygen) is higher the closer we are to the equator line.
Take home figure
Take home figure
Adapted from Bärtsch and Gibbs Physiological response to hypoxia. Life-sustaining oxygen delivery, in spite of a reduction in the partial pressure of inhaled oxygen between 25% and 60% (respectively at 2500 m and 8000 m), is ensured by an increase in pulmonary ventilation, an increase in cardiac output by increasing heart rate, changes in vascular tone, as well as an increase in haemoglobin concentration. BP, blood pressure; HR, heart rate; PaCO2, partial pressure of arterial carbon dioxide.
Figure 2
Figure 2
Systolic blood pressure profile for 24 h in a healthy volunteer at different altitudes. Blue line: sea level; yellow line: Namche Bazaar (3400 m); red line: Everest Base Camp 1 (5400 m).

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