Blood pressure response to exposure to moderate altitude in patients with COPD

Esther I Schwarz, Tsogyal D Latshang, Michael Furian, Deborah Flück, Sebastian Segitz, Severine Müller-Mottet, Silvia Ulrich, Konrad E Bloch, Malcolm Kohler, Esther I Schwarz, Tsogyal D Latshang, Michael Furian, Deborah Flück, Sebastian Segitz, Severine Müller-Mottet, Silvia Ulrich, Konrad E Bloch, Malcolm Kohler

Abstract

Purpose: Patients with COPD might be particularly susceptible to hypoxia-induced autonomic dysregulation. Decreased baroreflex sensitivity (BRS) and increased blood pressure (BP) variability (BPV) are markers of impaired cardiovascular autonomic regulation and there is evidence for an association between decreased BRS/increased BPV and high cardiovascular risk. The aim of this study was to evaluate the effect of short-term exposure to moderate altitude on BP and measures of cardiovascular autonomic regulation in COPD patients.

Materials and methods: Continuous morning beat-to-beat BP was noninvasively measured with a Finometer® device for 10 minutes at low altitude (490 m, Zurich, Switzerland) and for 2 days at moderate altitude (2,590 m, Davos Jakobshorn, Switzerland) - the order of altitude exposure was randomized. Outcomes of interest were mean SBP and DBP, BPV expressed as the coefficient of variation (CV), and spontaneous BRS. Changes between low altitude and day 1 and day 2 at moderate altitude were assessed by ANOVA for repeated measurements with Fisher's exact test analysis.

Results: Thirty-seven patients with moderate to severe COPD (mean±SD age 64±6 years, FEV1 60%±17%) were included. Morning SBP increased by +10.8 mmHg (95% CI: 4.7-17.0, P=0.001) and morning DBP by +5.0 mmHg (95% CI: 0.8-9.3, P=0.02) in response to altitude exposure. BRS significantly decreased (P=0.03), whereas BPV significantly and progressively increased (P<0.001) upon exposure to altitude.

Conclusion: Exposure of COPD patients to moderate altitude is associated with a clinically relevant increase in BP, which seems to be related to autonomic dysregulation.

Clinical trial registration: ClinicalTrials.gov (NCT01875133).

Keywords: COPD; baroreflex sensitivity; blood pressure variability; hypobaric hypoxia.

Conflict of interest statement

Disclosure The authors declare no conflict of interest in this work.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
ANOVA of repeated measurements. Notes: Comparison of (A) SBP, (B) DBP, (C) blood pressure variability, and (D) spontaneous baroreflex sensitivity (BRS) between low altitude and day 1 and day 2 at moderate altitude. Vertical bars denote 95% CIs. *P<0.05 vs 490 m. ^P<0.05 vs 2,590 m day 1.

References

    1. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187(4):347–365.
    1. Chen W, Thomas J, Sadatsafavi M, Fitzgerald JM. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(8):631–639.
    1. Sevre K, Bendz B, Hanko E, et al. Reduced autonomic activity during stepwise exposure to high altitude. Acta Physiol Scand. 2001;173(4):409–417.
    1. Sevre K, Bendz B, Rostrup M. Reduced baroreceptor reflex sensitivity and increased blood pressure variability at 2400 M simulated cabin altitude. Aviat Space Environ Med. 2002;73(7):632–634.
    1. Heindl S, Lehnert M, Criée CP, Hasenfuss G, Andreas S. Marked sympathetic activation in patients with chronic respiratory failure. Am J Respir Crit Care Med. 2001;164(4):597–601.
    1. Graham WG, Houston CS. Short-term adaptation to moderate altitude. Patients with chronic obstructive pulmonary disease. JAMA. 1978;240(14):1491–1494.
    1. Patakas D, Louridas G, Kakavelas E. Reduced baroreceptor sensitivity in patients with chronic obstructive pulmonary disease. Thorax. 1982;37(4):292–295.
    1. van Gestel AJR, Kohler M, Clarenbach CF. Sympathetic overactivity and cardiovascular disease in patients with chronic obstructive pulmonary disease (COPD) Discov Med. 2012;14(79):359–368.
    1. Bartels MN, Gonzalez JM, Kim W, de Meersman RE. Oxygen supplementation and cardiac-autonomic modulation in COPD. Chest. 2000;118(3):691–696.
    1. Rhodes HL, Chesterman K, Chan CW, et al. Systemic blood pressure, arterial stiffness and pulse waveform analysis at altitude. J R Army Med Corps. 2011;157(1):110–113.
    1. Kunisaki KM, Dransfield MT, Anderson JA, et al. Exacerbations of chronic obstructive pulmonary disease and cardiac events: a cohort analysis. Am J Respir Crit Care Med. 2018;198(1):51–57.
    1. Veglio M, Maule S, Cametti G, et al. The effects of exposure to moderate altitude on cardiovascular autonomic function in normal subjects. Clin Auton Res. 1999;9(3):123–127.
    1. Berg BW, Dillard TA, Derderian SS, Rajagopal KR. Hemodynamic effects of altitude exposure and oxygen administration in chronic obstructive pulmonary disease. Am J Med. 1993;94(4):407–412.
    1. Kourtidou-Papadeli C, Papadelis C, Koutsonikolas D, Boutzioukas S, Styliadis C, Guiba-Tziampiri O. High altitude cognitive performance and COPD interaction. Hippokratia. 2008;12(Suppl 1):84–90.
    1. La Rovere MT, Bigger JT, Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet. 1998;351(9101):478–484.
    1. Ormezzano O, Cracowski JL, Quesada JL, Pierre H, Mallion JM, Baguet JP. Evaluation of the prognostic value of baroreflex sensitivity in hypertensive patients: the EVABAR study. J Hypertens. 2008;26(7):1373–1378.
    1. Parati G, Ulian L, Santucciu C, Omboni S, Mancia G. Blood pressure variability, cardiovascular risk and antihypertensive treatment. J Hypertens Suppl. 1995;13(4):S27–S34.
    1. Bombelli M, Fodri D, Toso E, et al. Relationship among morning blood pressure surge, 24-hour blood pressure variability, and cardiovascular outcomes in a white population. Hypertension. 2014;64(5):943–950.
    1. Parati G, Ochoa JE, Bilo G. Blood pressure variability, cardiovascular risk, and risk for renal disease progression. Curr Hypertens Rep. 2012;14(5):421–431.
    1. Suchy-Dicey AM, Wallace ER, Mitchell SV, et al. Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study. Am J Hypertens. 2013;26(10):1210–1217.
    1. Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375(9718):895–905.
    1. Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens. 1987;5(1):93–98.
    1. DiCarlo SE, Bishop VS. Central baroreflex resetting as a means of increasing and decreasing sympathetic outflow and arterial pressure. Ann N Y Acad Sci. 2001;940(1):324–337.
    1. Latshang TD, Tardent RPM, Furian M, et al. Sleep and breathing disturbances in patients with chronic obstructive pulmonary disease traveling to altitude: a randomized trial. Sleep. 2019;42(1)
    1. Latshang TD, Furian M, Flück D, et al. Effect of travelling to 2590 m on 6-minute walk distance, blood gases and symptoms of acute mountain sickness in COPD patients. Eur Respir J. 2014;44:P3630.
    1. Puhan MA, Mador MJ, Held U, Goldstein R, Guyatt GH, Schunemann HJ. Interpretation of treatment changes in 6-minute walk distance in patients with COPD. Eur Respir J. 2008;32(3):637–643.
    1. Latshang TD, Lo Cascio CM, Stöwhas AC, et al. Are nocturnal breathing, sleep, and cognitive performance impaired at moderate altitude (1,630–2,590 M)? Sleep. 2013;36(12):1969–1976.
    1. Heart rate variability: standards of measurement, physiological interpretation and clinical use Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043–1065.
    1. Imholz BP, Wieling W, van Montfrans GA, Wesseling KH. Fifteen years experience with finger arterial pressure monitoring: assessment of the technology. Cardiovasc Res. 1998;38(3):605–616.
    1. Kardos A, Watterich G, de Menezes R, Csanády M, Casadei B, Rudas L. Determinants of spontaneous baroreflex sensitivity in a healthy working population. Hypertension. 2001;37(3):911–916.
    1. Stöwhas AC, Latshang TD, Lo Cascio CM, et al. Effects of acute exposure to moderate altitude on vascular function, metabolism and systemic inflammation. PLoS One. 2013;8(8):e70081.
    1. Mancia G, Ferrari A, Gregorini L, et al. Blood pressure variability in man: its relation to high blood pressure, age and baroreflex sensitivity. Clin Sci. 1980;59(s6):401s–404s.
    1. Johansson JK, Puukka PJ, Virtanen R, Jula AM. Beat-to-beat, ambulatory hour-to-hour, and home day-to-day variabilities in blood pressure, pulse pressure, and heart rate in comparison with each other and with target-organ damage. Blood Press Monit. 2015;20(3):113–120.
    1. Webb AJS, Rothwell PM. Physiological correlates of beat-to-beat, ambulatory, and day-to-day home blood pressure variability after transient ischemic attack or minor stroke. Stroke. 2014;45(2):533–538.
    1. Furian M, Hartmann SE, Latshang TD, et al. Exercise performance of Lowlanders with COPD at 2,590 m: data from a randomized trial. Respiration. 2018;95(6):422–432.
    1. Lichtblau M, Latshang TD, Furian M, et al. Right and left heart function in lowlanders with COPD at altitude: data from a randomized study. Respiration. 2019;97(2):125–134.
    1. Kanstrup IL, Poulsen TD, Hansen JM, et al. Blood pressure and plasma catecholamines in acute and prolonged hypoxia: effects of local hypothermia. J Appl Physiol (1985) 1999;87(6):2053–2058.
    1. Mazzeo RS, Wolfel EE, Butterfield GE, Reeves JT. Sympathetic response during 21 days at high altitude (4,300 M) as determined by urinary and arterial catecholamines. Metabolism. 1994;43(10):1226–1232.
    1. Dhar P, Sharma VK, Hota KB, et al. Autonomic cardiovascular responses in acclimatized lowlanders on prolonged stay at high altitude: a longitudinal follow up study. PLoS One. 2014;9(1):e84274.
    1. Wu YK, Huang CY, Yang MC, Huang GL, Chen SY, Lan CC. Effect of tiotropium on heart rate variability in stable chronic obstructive pulmonary disease patients. J Aerosol Med Pulm Drug Deliv. 2015;28(2):100–105.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel