Skip to main content

Advertisement

Log in

The effect of high altitude on central blood pressure and arterial stiffness

  • Original Article
  • Published:
Journal of Human Hypertension Submit manuscript

Abstract

Central arterial systolic blood pressure (SBP) and arterial stiffness are known to be better predictors of adverse cardiovascular outcomes than brachial SBP. The effect of progressive high altitude (HA) on these parameters has not been examined. Ninety healthy adults were included. Central BP and the augmentation index (AI) were measured at the level of the brachial artery (Uscom BP+ device) at <200 m and at 3619, 4600 and 5140 m. The average age of the subjects (70% men) were 32.2±8.7 years. Compared with central arterial pressures, brachial SBP (+8.1±6.4 mm Hg; P<0.0001) and pulse pressure (+10.9±6.6 mm Hg; P<0.0001) were significantly higher and brachial diastolic BP was lower (−2.8±1.6 mm Hg; P<0.0001). Compared with <200 m, HA led to a significant increase in brachial and central SBP. Central SBP correlated with AI (r=0.50; 95% confidence interval (CI): 0.41–0.58; P<0.0001) and age (r=0.32; 95% CI: 21–0.41; P<0.001). AI positively correlated with age (r=0.39; P<0.001) and inversely with subject height (r=−0.22; P<0.0001), weight (r=−0.19; P=0.006) and heart rate (r=−0.49; P<0.0001). There was no relationship between acute mountain sickness scores (Lake Louis Scoring System (LLS)) and AI or central BP. The independent predictors of central SBP were male sex (coefficient, t=4.7; P<0.0001), age (t=3.6; P=0.004) and AI (t=7.5; P<0.0001; overall r2=0.40; P<0.0001). Subject height (t=2.4; P=0.02), age (7.4; P<0.0001) and heart rate (t=11.4; P<0.0001) were the only independent predictors of AI (overall r2=0.43; P<0.0001). Central BP and AI significantly increase at HA. This rise was influenced by subject-related factors and heart rate but not independently by altitude, LLS or SpO2.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Burtscher M, Ponchia A . The risk of cardiovascular events during leisure time activities at altitude. Prog Cardiovasc Dis 2010; 52: 507–511.

    Article  Google Scholar 

  2. Bärtsch P, Gibbs JS . Effect of altitude on the heart and the lungs. Circulation 2007; 116: 2191–2202.

    Article  Google Scholar 

  3. Boushel R, Calbet J-AL, Rådegran G, Søndergaard MS, Wagner PD, Saltin B . Parasympathetic neural activity accounts for the lowering of exercise heart rate at high altitude. Circulation 2001; 104: 1785–1791.

    Article  CAS  Google Scholar 

  4. Boos CJ, Mellor A, Begley J, Stacey M, Smith C, Hawkins A et al. The effects of exercise at high altitude on high-sensitivity cardiac troponin release and associated biventricular cardiac function. Clin Res Cardiol 2014; 103: 291–299.

    Article  CAS  Google Scholar 

  5. Naeije R . Physiological adaptation of the cardiovascular system to high altitude. Prog Cardiovasc Dis 2010; 52: 456–466.

    Article  Google Scholar 

  6. Rhodes HL, Chesterman K, Chan CW, Collins P, Kewley E, Pattinson KT et al. Birmingham Medical Research Expeditionary Society. Systemic blood pressure, arterial stiffness and pulse waveform analysis at altitude. J R Army Med Corps 2011; 157: 110–113.

    Article  CAS  Google Scholar 

  7. Schultz MG, Climie RE, Sharman JE . Ambulatory and central haemodynamics during progressive ascent to high-altitude and associated hypoxia. J Hum Hypertens 2014; 28: 705–710.

    Article  CAS  Google Scholar 

  8. 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; 34: 759–766.

    Article  CAS  Google Scholar 

  9. 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; 65: 1266–1272.

    Article  CAS  Google Scholar 

  10. McEniery CM, Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB . Central blood pressure: current evidence and clinical importance. Eur Heart J 2014; 35: 1719–1725.

    Article  Google Scholar 

  11. Safar ME, Blacher J, Jankowski P . Arterial stiffness, pulse pressure, and cardiovascular disease—is it possible to break the vicious circle? Atherosclerosis 2011; 218: 263–271.

    Article  CAS  Google Scholar 

  12. Lowe A, HarrisonW, El-Aklouk E, Ruygrok P, Al-Jumaily AM . Non-invasive model based estimation of aortic pulse pressure using suprasystolic brachial pressure waveforms. J Biomech 2009; 42: 2111–2115.

    Article  CAS  Google Scholar 

  13. Lin AC, Lowe A, Sidhu K, Harrison W, Ruygrok P, Stewart R . Evaluation of a novel sphygmomanometer, which estimates central aortic blood pressure from analysis of brachial artery suprasystolic pressure waves. J Hypertens 2012; 30: 1743–1750.

    Article  CAS  Google Scholar 

  14. Climie RE, Schultz MG, Nikolic SB, Ahuja KD, Fell JW, Sharman JE . Validity and reliability of central blood pressure estimated by upper arm oscillometric cuff pressure. Am J Hypertens 2012; 25: 414–420.

    Article  Google Scholar 

  15. Costello BT, Schultz MG, Black JA, Sharman JE . Evaluation of a brachial cuff and suprasystolic waveform algorithm method to noninvasively derive central blood pressure. Am J Hypertens 2015; 28: 480–486.

    Article  Google Scholar 

  16. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D et al. European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27: 2588–2605.

    Article  Google Scholar 

  17. Hackett PH, Oelz O. In: Sutton JR, Houston CS, Coates G (eds). Hypoxia and Mountain Medicine. Queen City Printers: Burlington, VT, USA, 1992, pp 327–330.

    Google Scholar 

  18. Roach RC, Bärtsch P, Oelz O, Hackett PH. In: Hypoxia and Molecular Medicine. Queens City Press: Burlington, VT, USA, 1993, pp 272–274.

    Google Scholar 

  19. Michard F, Lopes MR, Auler JO Jr . Pulse pressure variation: beyond the fluid management of patients with shock. Crit Care 2007; 11: 131.

    Article  Google Scholar 

  20. Marik PE, Cavallazzi R, Vasu T, Hirani A . Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 2009; 37: 2642–2647.

    Article  Google Scholar 

  21. Biais M, Ouattara A, Janvier G, Sztark F . Case scenario: respiratory variations in arterial pressure for guiding fluid management in mechanically ventilated patients. Anesthesiology 2012; 116: 1354–1361.

    Article  Google Scholar 

  22. Boos CJ, O’Hara JP, Mellor A, Hodkinson PD, Tsakirides C, Reeve N et al. A four-way comparison of cardiac function with normobaric normoxia, normobaric hypoxia, hypobaric hypoxia and genuine high altitude. PLoS ONE 2016; 11: e0152868.

    Article  Google Scholar 

  23. Ramirez G, Hammond M, Agosti SJ, Bittle PA, Dietz JR, Colice GL . Effects of hypoxemia at sea level and high altitude on sodium excretion and hormonal levels. Aviat Space Environ Med 1992; 63: 891–898.

    CAS  PubMed  Google Scholar 

  24. Koller EA, Drechsel S, Hess T, Macherel P, Boutellier U . Effects of atropine and propranolol on the respiratory, circulatory, and ECG responses to high altitude in man. Eur J Appl Physiol Occup Physiol 1988; 57: 163–172.

    Article  CAS  Google Scholar 

  25. Boos CJ, Hodkinson P, Mellor A, Green NP, Woods DR . The effects of acute hypobaric hypoxia on arterial stiffness and endothelial function and its relationship to changes in pulmonary artery pressure and left ventricular diastolic function. High Alt Med Biol 2012; 13: 105–111.

    Article  CAS  Google Scholar 

  26. Coppel J, Hennis P, Gilbert-Kawai E, Grocott MP . The physiological effects of hypobaric hypoxia versus normobaric hypoxia: a systematic review of crossover trials. Extrem Physiol Med 2015; 4: 1–20.

    Article  Google Scholar 

  27. Smulyan H, Marchais SJ, Pannier B, Guerin AP, Safar ME, London GM . Influence of body height on pulsatile arterial hemodynamic data. J Am Coll Cardiol 1998; 31: 1103–1109.

    Article  CAS  Google Scholar 

  28. Wilkinson IB, Mohammad NH, Tyrrell S, Hall IR, Webb DJ, Paul VE et al. Heart rate dependency of pulse pressure amplification and arterial stiffness. Am J Hypertens 2002; 15: 24–30.

    Article  Google Scholar 

  29. Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ . The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 2000; 525: 263–270.

    Article  CAS  Google Scholar 

  30. Stoner L, Faulkner J, Lowe A, Lambrick D, Young, Love R et al. Should the augmentation index be normalized to heart rate? J Atheroscler Thromb 2014; 21: 11–16.

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge and thank the staff in the Department of Cardiology at Poole Hospital for their support. We are extremely grateful to the subjects for their time and for volunteering to take part in this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C J Boos.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boos, C., Vincent, E., Mellor, A. et al. The effect of high altitude on central blood pressure and arterial stiffness. J Hum Hypertens 31, 715–719 (2017). https://doi.org/10.1038/jhh.2017.40

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2017.40

  • Springer Nature Limited

This article is cited by

Navigation