Abstract
Alveolar hypoxia is the most prominent feature of high altitude environment with well-known consequences for the cardio-pulmonary system, including development of pulmonary hypertension. Pulmonary hypertension due to an exaggerated hypoxic pulmonary vasoconstriction contributes to high altitude pulmonary edema (HAPE), a life-threatening disorder, occurring at high altitudes in non-acclimatized healthy individuals. Despite a strong physiologic rationale for using vasodilators for prevention and treatment of HAPE, no systematic studies of their efficacy have been conducted to date. Calcium-channel blockers are currently recommended for drug prophylaxis in high-risk individuals with a clear history of recurrent HAPE based on the extensive clinical experience with nifedipine in HAPE prevention in susceptible individuals. Chronic exposure to hypoxia induces pulmonary vascular remodeling and development of pulmonary hypertension, which places an increased pressure load on the right ventricle leading to right heart failure. Further, pulmonary hypertension along with excessive erythrocytosis may complicate chronic mountain sickness, another high altitude maladaptation disorder. Importantly, other causes than hypoxia may potentially underlie and/or contribute to pulmonary hypertension at high altitude, such as chronic heart and lung diseases, thrombotic or embolic diseases. Extensive clinical experience with drugs in patients with pulmonary arterial hypertension suggests their potential for treatment of high altitude pulmonary hypertension. Small studies have demonstrated their efficacy in reducing pulmonary artery pressure in high altitude residents. However, no drugs have been approved to date for the therapy of chronic high altitude pulmonary hypertension. This work provides a literature review on the role of pulmonary hypertension in the pathogenesis of acute and chronic high altitude maladaptation disorders and summarizes current knowledge regarding potential treatment options.
Highlights
A large portion of human population has inhabited high altitude settings, such as the mountainous geographic locations of the Andes, Tibet, Ethiopian highlands, Pamir, andTian-Shan
Further evidence supporting the critical role of HIF2α in the development of hypoxic pulmonary hypertension was provided by demonstration of high association of two EPAS1 variants, which are likely a gain-of-function mutation, with pulmonary hypertension in cattle residing at high altitude [256]
Hypoxic pulmonary hypertension plays an important role in the pathogenesis of high altitude pulmonary edema (HAPE)
Summary
A large portion of human population has inhabited high altitude settings, such as the mountainous geographic locations of the Andes, Tibet, Ethiopian highlands, Pamir, and. Res. Public Health 2021, 18, 1692 economic or recreational purposes has been constantly increasing during last decades [1]. High altitude is one of the most important extreme environments, characterized by many challenges [2]. Alveolar hypoxia is the most prominent among them, with recognized consequences for the cardio-pulmonary system, including development of pulmonary hypertension [3]. Chronic exposure to high altitude hypoxia induces pulmonary vascular remodeling and development of sustained pulmonary hypertension, which places an increased pressure load on the right ventricle, leading to right heart failure and premature death [5]. This work provides a literature review on the role of pulmonary hypertension in the pathogenesis of acute and chronic high altitude maladaptation disorders and summarizes current knowledge regarding potential treatment options
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
