Effects of selective and nonselective beta-blockade on 24-h ambulatory blood pressure under hypobaric hypoxia at altitude

Bilo, Grzegorz; Caldara, G; Styczkiewicz, Katarzyna; Revera, Miriam; Lombardi, Carolina; Giglio, A.; Zambon, Antonella; Corrao, Giovanni; Faini, Andrea; Valentini, Mariaconsuelo; Mancia, Giuseppe; Parati, Gianfranco

doi:10.1097/hjh.0b013e3283409014

Cited by 44 publications

(52 citation statements)

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“…On the basis of data from previous studies, 8,17 we estimated that the primary efficacy variable (24-hour ambulatory SBP at high altitude) would have a SD of 12 mm Hg within each group. On the basis of this estimate, 84 patients (42 per each of the 2 treatment groups) were needed to identify an 8 mm Hg difference in the primary efficacy variable between the study groups with a power of 80% and type I error rate of 0.05, assuming a 10% patient dropout.…”

Section: Sample Sizementioning

confidence: 99%

“…2,[5][6][7][8] Millions of subjects travel for relatively short periods of time to high altitude either for work or for leisure including many affected by hypertension 9 in whom the pressor effect of high altitude may be relevant. Limited information is available, however, on the acute BP effects of high altitude in hypertensive subjects, 10 and on the effectiveness and tolerability of antihypertensive drugs under these circumstances.…”

mentioning

confidence: 99%

“…Unique identifier: NCT01830530. Aims of the present study were to extend the information on the acute effects of high altitude on conventional and 24-hour BP obtained in previous studies in normotensive volunteers 8,17 to hypertensive subjects residing at sea level, and to determine whether the efficacy of antihypertensive treatment with the combination of an ARB (telmisartan) and a slow release calcium antagonist (nifedipine gastrointestinal therapeutic system [GITS]) is maintained at high altitude.The study was conducted in the frame of the High Altitude Cardiovascular Research (HIGHCARE)-Andes Lowlanders Study. …”

mentioning

confidence: 99%

“…16,17 Two previous studies reported that β-blockers have a limited effect in preventing the 24-hour BP increase that occurs at high altitude, 8,28 and their use (particularly of carvedilol) is associated with lower SpO 2 , worse tolerability, and exercise capacity. 8,35 In the healthy participants of HIGHCARE-HIMALAYA, we observed that BP-lowering effect of telmisartan monotherapy was maintained ≤3400 m but not at higher altitudes (5400 m), with no tolerability issues. 17 In the hypertensive participants of the present study, the combined treatment with telmisartan and nifedipine was effective and safe at an altitude (3260 m) similar to the lower altitude reached in HIGHCARE-HIMALAYA, with BP values that remained lower than in placebo-treated subjects, as it occurred at sea level.…”

mentioning

confidence: 99%

“…15,16 Furthermore, the calcium antagonist nifedipine lowers pulmonary pressure typically elevated at high altitude and is used in prevention and treatment of high-altitude pulmonary edema. 4 Aims of the present study were to extend the information on the acute effects of high altitude on conventional and 24-hour BP obtained in previous studies in normotensive volunteers 8,17 to hypertensive subjects residing at sea level, and to determine whether the efficacy of antihypertensive treatment with the combination of an ARB (telmisartan) and a slow release calcium antagonist (nifedipine gastrointestinal therapeutic system [GITS]) is maintained at high altitude.…”

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confidence: 99%

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Ambulatory Blood Pressure in Untreated and Treated Hypertensive Patients at High Altitude

et al. 2015

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A cute exposure to high-altitude hypoxia induces important changes in cardiovascular regulation, [1][2][3][4] including an increase in blood pressure (BP) and heart rate (HR). 2,[5][6][7][8] Millions of subjects travel for relatively short periods of time to high altitude either for work or for leisure including many affected by hypertension 9 in whom the pressor effect of high altitude may be relevant. Limited information is available, however, on the acute BP effects of high altitude in hypertensive subjects, 10 and on the effectiveness and tolerability of antihypertensive drugs under these circumstances. As a result, the few recommendations published on the management of hypertensive subjects planning to spend time at high altitude for either leisure or work are largely based on experts' opinion rather than on evidence. 2,[11][12][13][14] Both angiotensin receptor blockers (ARBs) and dihydropyridine calcium antagonists are widely used for the monotherapy of hypertension, and their combination has been included among the preferred therapeutic choices by recent Abstract-Blood pressure increases during acute exposure to high altitude in healthy humans. However, little is known on altitude effects in hypertensive subjects or on the treatment efficacy in this condition. Objectives of High Altitude Cardiovascular Research (HIGHCARE)-Andes Lowlanders Study were to investigate the effects of acute high-altitude exposure on 24-hour ambulatory blood pressure in hypertensive subjects and to assess antihypertensive treatment efficacy in this setting. One hundred untreated subjects with mild hypertension (screening blood pressure, 144.1±9.8 mm Hg systolic, 92.0±7.5 mm Hg diastolic) were randomized to double-blind placebo or to telmisartan 80 mg+modified release nifedipine 30 mg combination. Twenty-four-hour ambulatory blood pressure monitoring was performed off-treatment, after 6 weeks of treatment at sea level, on treatment during acute exposure to high altitude (3260 m) and immediately after return to sea level. Eighty-nine patients completed the study (age, 56.4±17.6 years; 52 men/37 women; body mass index, 28.2±3.5 kg/ m 2 ). Twenty-four-hour systolic blood pressure increased at high altitude in both groups (placebo, 11.0±9 mm Hg; P<0.001 and active treatment, 8.1±10.4 mm Hg; P<0.001). Active treatment reduced 24-hour systolic blood pressure both at sea level and at high altitude (147.9±11.1 versus 132.6±12.4 mm Hg for placebo versus treated; P<0.001; 95% confidence interval of the difference 10.9-19.9 mm Hg) and was well tolerated. Similar results were obtained for diastolic, for daytime blood pressure, and for nighttime blood pressure. Treatment was well tolerated in all conditions. Our study demonstrates that (1) 24-hour blood pressure increases significantly during acute high-altitude exposure in hypertensive subjects and (2) treatment with angiotensin receptor blocker-calcium channel blocker combination is effective and safe in this condition. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique...

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Section: Sample Sizementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Ambulatory Blood Pressure in Untreated and Treated Hypertensive Patients at High Altitude

et al. 2015

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Changes in blood pressure, oxygen saturation, hemoglobin concentration, and heart rate among low‐altitude migrants living at high altitude (5380 m) for 360 days

严艳

Zhong²,

Jia

et al. 2023

American J Hum Biol

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BackgroundThis article aimed to study the adjustment and adaptation of resting systolic blood pressure (SBP), diastolic blood pressure (DPB), oxygen saturation (SpO2), hemoglobin concentration ([Hb]), and heart rate (HR) in low‐altitude migrants during a 1‐year stay at high altitude.Materials and MethodsOur study enrolled 35 young migrants who were exposed to a hypoxia environment at 5380 m altitude on the Qinghai Tibetan Plateau between June 21, 2017, and June 16, 2018. We set 14‐time points (the 1st–10th, 20th, 30th, 180th, and 360th day after arriving at 5380 m) for obtaining the measurements of resting SBP, DBP, HR, SpO2, and [Hb] and compared them with the control values recorded prior to migration. Variables with continuous data were summarized as means (SD). One‐way repeated measures ANOVA without assuming sphericity was carried out to test whether the mean values (SBP, DBP, HR, SpO2, and [Hb]) on different days were different significantly. Furthermore, Dunnett's multiple comparisons test was carried out to determine the time points whose values were significantly different from the control values.ResultsSBP and DBP were continually increasing within d1‐3 and peaked on the 3rd day, then steadily declined from d3 to d30. SBP fell back to the control values on d10 (p > 0.05), and DBP fell back to the control values on d20 (p > 0.05). A significant decline occurred on d180 (p < 0.05). Both SBP and DBP were lower than the control values on d180 (p < 0.05), and this trend was maintained to d360. There were similar characteristics of HR and BP in the time course at HA. HR on d1‐3 was increasing (p < 0.05) compared to the control values, after which it fell back to the control values on d180 (p > 0.05), and this trend was maintained to d360. SpO2 was the lowest on d1 and lower than the control value throughout the study at HA (p < 0.05). [Hb] increased after long‐term exposure (180 and 360 days) to HA (p < 0.05).ConclusionsOur study continuously monitored lowlanders at 5380 m in Tibet, and is perhaps the only longitudinal study of migrants conducted at an altitude above 5000 m during a 1‐year period. Our study provides new information on the adjustment and adaptation of [Hb], SpO2, SBP, DBP, and HR in high‐altitude plateau migrants during a 360‐day stay at an altitude of 5380 m.

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Arterial Stiffness and the Sympathetic Nervous System

Parati

Salvi

2014

Blood Pressure and Arterial Wall Mechanics in Cardiovascular Diseases

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Effects of selective and nonselective beta-blockade on 24-h ambulatory blood pressure under hypobaric hypoxia at altitude

Cited by 44 publications

References 28 publications

Ambulatory Blood Pressure in Untreated and Treated Hypertensive Patients at High Altitude

Ambulatory Blood Pressure in Untreated and Treated Hypertensive Patients at High Altitude

Changes in blood pressure, oxygen saturation, hemoglobin concentration, and heart rate among low‐altitude migrants living at high altitude (5380 m) for 360 days

Arterial Stiffness and the Sympathetic Nervous System

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