Brain Natriuretic Peptide Levels and the Occurrence of Subclinical Pulmonary Edema in Healthy Lowlanders at High Altitude

Subclinical elevated B-type Natriuretic Peptide (BNP) indicates endothelial dysfunction contributing to hypoxia susceptibility in healthy individuals

“…The present study on HAPE patients showing elevated BNP (74.54 ± 32.98 pg/ml at 3200 m) measured within first three days of HA induction is in accordance to the previous study on mountaineers having BNP (40.7 pg/ml at 5642 m) [ 12 ] who suffered subclinical pulmonary edema with prophylactic acetazolamide. Another study on the military population showed severe AMS having BNP (58.4 pg/ml at 5150 m) on the ninth day of HA induction [ 9 ].…”

“…BNP is a known marker of vascular and myocardial remodeling associated with the HIF1α signaling pathway in various chronic disease conditions where stabilized HIF1α acts on the promotor site of the BNP gene [ 45 , 46 ]. Baseline elevated HIF1α and BNP levels (>15 pg/ml) were also found in subclinical comorbid states like pre-diabetes and subclinical pulmonary dysfunction in the present and previous studies [ 8 , 9 , 11 ] and have shown a predisposition to acute mountain sickness and high altitude pulmonary edema due to development of hypoxic pulmonary hypertension [ 8 , 12 ]. Similarly, COVID-19 patients with high baseline BNP levels >100 pg/ml at admission were associated with a poor prognosis due to the development of severe hypoxic pulmonary hypertension in comparison to those with lower initial BNP levels suggesting pre-existing vascular remodeling predispose to hypoxic injury [ 23 ].…”

“…Therefore, the present study was conducted on healthy individuals having average physical fitness at sea level to explore the screening ability of BNP for hypoxia susceptibility. BNP values at sea level were validated on sojourners who were passively inducted (by air) to high altitude (3200 m) and did not follow acclimatization schedule and suffered HAPE, unlike previous studies on mountaineers and army personnel [ 9 , 12 ]. We hypothesize that hypoxia susceptibility is related to endothelial dysfunction which correlates with subclinical elevation of BNP levels (>15 pg/ml).…”

Markers of physiological stress during exercise under conditions of normoxia, normobaric hypoxia, hypobaric hypoxia, and genuine high altitude

“…We, and others, have previously shown that highly sensitive cardiac troponin T (hscTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and cortisol are influenced by hypoxia and exercise (Rostrup 1998; Banfi et al 2010; Richalet et al 2010; Woods et al 2011a, 2012a, b; Mellor et al 2014; Heinonen et al 2014; Pagé et al 2015; Li et al 2016). An increased sympathoadrenal response has been reported with both acute and more prolonged HA exposure (Mazzeo et al 1995) that is further stimulated by exercise (Mazzeo et al 1991, 1995, 2000; Rostrup 1998).…”

Heart Failure in Patients With Preserved Ejection Fraction – Pumping Heart Failure?

“…Это может указывать на то, что решающую роль в клинических проявлениях ХСН играют не только нарушение циркуляции крови, но и массо-перенос кислорода и субстратов к тканям организма. Кроме того, в ранних экспериментальных исследованиях показано, что гипоксия стимулирует продукцию ANP и BNP [47], недавние клинические исследования подтвердили этот феномен [48]. У здоровых лиц при нарастании гипоксии на высотах от 3 000 до 5 642 м при подъеме на гору Эльбрус концентрация BNP достоверно повышалась, причем она четко зависела от уровня над поверхностью моря, т. е. степени гипоксии [49].…”