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Sydykov A, Mamazhakypov A, Maripov A, et al. Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders. Int J Environ Res Public Health. 2021;18(4)doi: 10.3390/ijerph18041692.
Sydykov, A., Mamazhakypov, A., Maripov, A., Kosanovic, D., Weissmann, N., Ghofrani, H. A., Sarybaev, A. S., & Schermuly, R. T. (2021). Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders. International journal of environmental research and public health, 18(4), . https://doi.org/10.3390/ijerph18041692
Sydykov, Akylbek, et al. "Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders." International journal of environmental research and public health vol. 18,4 (2021). doi: https://doi.org/10.3390/ijerph18041692
Sydykov A, Mamazhakypov A, Maripov A, Kosanovic D, Weissmann N, Ghofrani HA, Sarybaev AS, Schermuly RT. Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders. Int J Environ Res Public Health. 2021 Feb 10;18(4). doi: 10.3390/ijerph18041692. PMID: 33578749; PMCID: PMC7916528.
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Int J Environ Res Public Health. 2021 Feb 10;18(4). doi: 10.3390/ijerph18041692.

Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders.

International journal of environmental research and public health

Akylbek Sydykov, Argen Mamazhakypov, Abdirashit Maripov, Djuro Kosanovic, Norbert Weissmann, Hossein Ardeschir Ghofrani, Akpay Sh Sarybaev, Ralph Theo Schermuly

Affiliations

  1. Department of Internal Medicine, Excellence Cluster Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Justus Liebig University of Giessen, Aulweg 130, 35392 Giessen, Germany.
  2. Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek 720040, Kyrgyzstan.
  3. Kyrgyz-Indian Mountain Biomedical Research Center, Bishkek 720040, Kyrgyzstan.
  4. Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), 119992 Moscow, Russia.

PMID: 33578749 PMCID: PMC7916528 DOI: 10.3390/ijerph18041692

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.

Keywords: chronic mountain sickness; high altitude; high altitude pulmonary edema; hypoxic pulmonary vasoconstriction; pulmonary hypertension

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