1
|
Rojas-Chambilla RA, Vilca-Coaquira KM, Tejada-Flores J, Tintaya-Ramos HO, Quispe-Trujillo MM, Calisaya-Huacasi ÁG, Quispe-Humpiri SA, Pino-Vanegas YM, Salazar-Granara AA, Tácuna-Calderón AL, García-Bedoya NM, Yang M, Viscor G, Hancco-Zirena I. Performance in the Six-Minute Walking Test Does Not Discriminate Excessive Erythrocytosis Patients in a Severe Hypoxic Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1119. [PMID: 39338002 PMCID: PMC11431577 DOI: 10.3390/ijerph21091119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Chronic exposure to severe hypoxia causes an increase in hematocrit (Hct) and hemoglobin concentration ([Hb]), which can lead to excessive erythrocytosis (EE) and impact physical performance. This work aims to determine the differences in the six-minute walking test (6MWT) between EE and healthy subjects residing at more than 5000 m. METHODS A prospective, cross-sectional study was performed on 71 men (36 healthy and 25 suffering from EE) living in La Rinconada, Peru (5100 m). Basal levels of [Hb] and Hct were obtained. All the subjects performed the 6MWT, and distance reached, vital signs, dyspnea, and fatigue (Borg scale) at the end of the test were recorded. RESULTS The average [Hb] and Hct levels in the control group were 18.7 ± 1.2 g/dL and 60.4 ± 7.1%, respectively, contrasting with EE subjects, who showed 23.4 ± 1.6 g/dL and 73.6 ± 5.9% (p < 0.001). However, no statistically significant differences were observed in BMI or other anthropometric parameters. At the end of the 6MWT, the distance traveled and vital constants were similar between both groups, except for arterial oxygen saturation, which was consistently lower in subjects with EE throughout the test. CONCLUSION EE does not significantly affect 6MWT performance at high altitudes, nor the hemodynamic control during moderate aerobic exercise of subjects who live permanently in a severely hypoxic environment.
Collapse
Affiliation(s)
- Rossela Alejandra Rojas-Chambilla
- Facultad de Medicina Humana, Universidad Nacional del Altiplano, Puno 21000, Peru; (R.A.R.-C.); (K.M.V.-C.); (J.T.-F.); (H.O.T.-R.); (M.M.Q.-T.); (Á.G.C.-H.); (S.A.Q.-H.)
- Asociación Científica de Estudiantes de Medicina (ACEM), Puno 21000, Peru
| | - Kely Melina Vilca-Coaquira
- Facultad de Medicina Humana, Universidad Nacional del Altiplano, Puno 21000, Peru; (R.A.R.-C.); (K.M.V.-C.); (J.T.-F.); (H.O.T.-R.); (M.M.Q.-T.); (Á.G.C.-H.); (S.A.Q.-H.)
- Asociación Científica de Estudiantes de Medicina (ACEM), Puno 21000, Peru
| | - Jeancarlo Tejada-Flores
- Facultad de Medicina Humana, Universidad Nacional del Altiplano, Puno 21000, Peru; (R.A.R.-C.); (K.M.V.-C.); (J.T.-F.); (H.O.T.-R.); (M.M.Q.-T.); (Á.G.C.-H.); (S.A.Q.-H.)
- Asociación Científica de Estudiantes de Medicina (ACEM), Puno 21000, Peru
| | - Henry Oscar Tintaya-Ramos
- Facultad de Medicina Humana, Universidad Nacional del Altiplano, Puno 21000, Peru; (R.A.R.-C.); (K.M.V.-C.); (J.T.-F.); (H.O.T.-R.); (M.M.Q.-T.); (Á.G.C.-H.); (S.A.Q.-H.)
- Asociación Científica de Estudiantes de Medicina (ACEM), Puno 21000, Peru
| | - Mariela Mercedes Quispe-Trujillo
- Facultad de Medicina Humana, Universidad Nacional del Altiplano, Puno 21000, Peru; (R.A.R.-C.); (K.M.V.-C.); (J.T.-F.); (H.O.T.-R.); (M.M.Q.-T.); (Á.G.C.-H.); (S.A.Q.-H.)
- Asociación Científica de Estudiantes de Medicina (ACEM), Puno 21000, Peru
| | - Ángel Gabriel Calisaya-Huacasi
- Facultad de Medicina Humana, Universidad Nacional del Altiplano, Puno 21000, Peru; (R.A.R.-C.); (K.M.V.-C.); (J.T.-F.); (H.O.T.-R.); (M.M.Q.-T.); (Á.G.C.-H.); (S.A.Q.-H.)
- Asociación Científica de Estudiantes de Medicina (ACEM), Puno 21000, Peru
| | - Solanyela Anny Quispe-Humpiri
- Facultad de Medicina Humana, Universidad Nacional del Altiplano, Puno 21000, Peru; (R.A.R.-C.); (K.M.V.-C.); (J.T.-F.); (H.O.T.-R.); (M.M.Q.-T.); (Á.G.C.-H.); (S.A.Q.-H.)
- Asociación Científica de Estudiantes de Medicina (ACEM), Puno 21000, Peru
| | - Yony Martin Pino-Vanegas
- Escuela Profesional de Educación Física, Facultad de Ciencias de la Educación, Universidad Nacional del Altiplano, Puno 21000, Peru;
| | - Alberto Alcibiades Salazar-Granara
- Centro de Investigación en Medicina de Altura (CIMA), Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15024, Peru; (A.A.S.-G.); (A.L.T.-C.); (N.M.G.-B.)
| | - Ana Lucía Tácuna-Calderón
- Centro de Investigación en Medicina de Altura (CIMA), Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15024, Peru; (A.A.S.-G.); (A.L.T.-C.); (N.M.G.-B.)
| | - Nancy Mónica García-Bedoya
- Centro de Investigación en Medicina de Altura (CIMA), Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15024, Peru; (A.A.S.-G.); (A.L.T.-C.); (N.M.G.-B.)
| | - Moua Yang
- Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Bloodworks Northwest Research Institute, Seattle, WA 98102, USA
- Division of Hematology and Oncology, Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98102, USA
| | - Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, E-08028 Barcelona, Spain
| | - Iván Hancco-Zirena
- Centro de Investigación en Medicina de Altura (CIMA), Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15024, Peru; (A.A.S.-G.); (A.L.T.-C.); (N.M.G.-B.)
- Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| |
Collapse
|
2
|
Vignati C, Contini M, Salvioni E, Lombardi C, Caravita S, Bilo G, Swenson ER, Parati G, Agostoni P. Exercise in hypoxia: a model from laboratory to on-field studies. Eur J Prev Cardiol 2023; 30:ii40-ii46. [PMID: 37819224 DOI: 10.1093/eurjpc/zwad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 10/13/2023]
Abstract
Clinical outcome and quality of life of patients with chronic heart failure (HF) have greatly improved over the last two decades. These results and the availability of modern lifts allow many cardiac patients to spend leisure time at altitude. Heart failure per se does not impede a safe stay at altitude, but exercise at both simulated and real altitudes is associated with a reduction in performance, which is inversely proportional to HF severity. For example, in normal subjects, the reduction in functional capacity is ∼2% every 1000 m altitude increase, whereas it is 4 and 10% in HF patients with normal or slightly diminished exercise capacity and in HF patients with markedly diminished exercise capacity, respectively. Also, the on-field experience with HF patients at altitude confirms safety and shows overall similar data to that reported at simulated altitude. Even 'optimal' HF treatment in patients spending time at altitude or at hypoxic conditions is likely different from optimal treatment at sea level, particularly with regard to the selectivity of β-blockers. Furthermore, high altitude, both simulated and on-field, represents a stimulating model of hypoxia in HF patients and healthy subjects. Our data suggest that spending time at altitude (<3500 m) can be safe even for HF patients, provided that subjects are free from comorbidities that may directly interfere with the adaptation to altitude and are stable. However, HF patients experience a reduction of exercise capacity directly proportional to HF severity and altitude. Finally, HF patients should be tested for functional capacity and must undergo a specific 'hypoxic-tailored treatment' to avoid pharmacological interference with altitude adaptation mechanisms, particularly with regard to the selectivity of β-blockers.
Collapse
Affiliation(s)
- Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Via Parea, Milano 20138, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Parea, Milano 20138, Italy
| | - Mauro Contini
- Centro Cardiologico Monzino, IRCCS, Via Parea, Milano 20138, Italy
| | | | - Carolina Lombardi
- Sleep Medicine Center, Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Erik R Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea, Milano 20138, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Parea, Milano 20138, Italy
| |
Collapse
|
3
|
Furian M, Tannheimer M, Burtscher M. Effects of Acute Exposure and Acclimatization to High-Altitude on Oxygen Saturation and Related Cardiorespiratory Fitness in Health and Disease. J Clin Med 2022; 11:6699. [PMID: 36431176 PMCID: PMC9697047 DOI: 10.3390/jcm11226699] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Maximal values of aerobic power (VO2max) and peripheral oxygen saturation (SpO2max) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO2 and related VO2max in healthy and diseased individuals have been much less considered. Therefore, this narrative review was primarily aimed to identify relevant literature reporting altitude-dependent changes in determinants, in particular SpO2, of VO2max and effects of acclimatization in athletes, healthy non-athletes, and patients suffering from cardiovascular, respiratory and/or metabolic diseases. Moreover, focus was set on potential differences with regard to baseline exercise performance, age and sex. Main findings of this review emphasize the close association between individual SpO2 and VO2max, and demonstrate similar altitude effects (acute and during acclimatization) in healthy people and those suffering from cardiovascular and metabolic diseases. However, in patients with ventilatory constrains, i.e., chronic obstructive pulmonary disease, steep decline in SpO2 and V̇O2max and reduced potential to acclimatize stress the already low exercise performance. Finally, implications for prevention and therapy are briefly discussed.
Collapse
Affiliation(s)
- Michael Furian
- Pulmonary Division, University Hospital Zurich, 8092 Zurich, Switzerland
- Research Department, Swiss University of Traditional Chinese Medicine, 5330 Bad Zurzach, Switzerland
| | - Markus Tannheimer
- Department of Sport and Rehabilitation Medicine, University of Ulm, 89075 Ulm, Germany
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
4
|
Adaptive cardiorespiratory changes to chronic continuous and intermittent hypoxia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 188:103-123. [PMID: 35965023 PMCID: PMC9906984 DOI: 10.1016/b978-0-323-91534-2.00009-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This chapter reviews cardiorespiratory adaptations to chronic hypoxia (CH) experienced at high altitude and cardiorespiratory pathologies elicited by chronic intermittent hypoxia (CIH) occurring with obstructive sleep apnea (OSA). Short-term CH increases breathing (ventilatory acclimatization to hypoxia) and blood pressure (BP) through carotid body (CB) chemo reflex. Hyperplasia of glomus cells, alterations in ion channels, and recruitment of additional excitatory molecules are implicated in the heightened CB chemo reflex by CH. Transcriptional activation of hypoxia-inducible factors (HIF-1 and 2) is a major molecular mechanism underlying respiratory adaptations to short-term CH. High-altitude natives experiencing long-term CH exhibit blunted hypoxic ventilatory response (HVR) and reduced BP due to desensitization of CB response to hypoxia and impaired processing of CB sensory information at the central nervous system. Ventilatory changes evoked by long-term CH are not readily reversed after return to sea level. OSA patients and rodents subjected to CIH exhibit heightened CB chemo reflex, increased hypoxic ventilatory response, and hypertension. Increased generation of reactive oxygen species (ROS) is a major cellular mechanism underlying CIH-induced enhanced CB chemo reflex and the ensuing cardiorespiratory pathologies. ROS generation by CIH is mediated by nontranscriptional, disrupted HIF-1 and HIF-2-dependent transcriptions as well as epigenetic mechanisms.
Collapse
|
5
|
Cornwell WK, Baggish AL, Bhatta YKD, Brosnan MJ, Dehnert C, Guseh JS, Hammer D, Levine BD, Parati G, Wolfel EE. Clinical Implications for Exercise at Altitude Among Individuals With Cardiovascular Disease: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2021; 10:e023225. [PMID: 34496612 PMCID: PMC8649141 DOI: 10.1161/jaha.121.023225] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An increasing number of individuals travel to mountainous environments for work and pleasure. However, oxygen availability declines at altitude, and hypoxic environments place unique stressors on the cardiovascular system. These stressors may be exacerbated by exercise at altitude, because exercise increases oxygen demand in an environment that is already relatively oxygen deplete compared with sea‐level conditions. Furthermore, the prevalence of cardiovascular disease, as well as diseases such as hypertension, heart failure, and lung disease, is high among individuals living in the United States. As such, patients who are at risk of or who have established cardiovascular disease may be at an increased risk of adverse events when sojourning to these mountainous locations. However, these risks may be minimized by appropriate pretravel assessments and planning through shared decision‐making between patients and their managing clinicians. This American Heart Association scientific statement provides a concise, yet comprehensive overview of the physiologic responses to exercise in hypoxic locations, as well as important considerations for minimizing the risk of adverse cardiovascular events during mountainous excursions.
Collapse
|
6
|
Lang M, Bilo G, Caravita S, Parati G. [Blood pressure and high altitude: physiological response and clinical management]. Medwave 2021; 21:e8194. [PMID: 34037579 DOI: 10.5867/medwave.2021.04.8194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/19/2021] [Indexed: 11/27/2022] Open
Abstract
High altitude is an extreme environment that challenges human beings exposed because of work, recreational activities, or habitat. Exposure to hypobaric hypoxia results in physiological adaptations in response to the geography and the associated extreme environmental conditions. These acclimatization responses can be diverse and result from evolutionary changes and comorbidities. In this context, this review aims to identify the available evidence on the effects of high altitude on blood pressurefrom the physiological to clinical aspects at rest and during exerciseand the underlying mechanisms and possible clinical implications of acute and chronic intermittent hypoxia.
Collapse
Affiliation(s)
- Morin Lang
- Department of Rehabilitation Sciences and Human Movement, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile. Address: Avenida Angamos 601, Antofagasta, Chile. . ORCID: 0000-0002-8465-5471
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. ORCID: 0000-0002-5104-9176
| | - Sergio Caravita
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy. ORCID: 0000-0002-3003-6499
| | - Gianfranco Parati
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. ORCID: 0000-0001-9402-7439
| |
Collapse
|
7
|
Vontobel J. [Heart Patients and Exposure to Altitude]. PRAXIS 2021; 110:303-311. [PMID: 33906438 DOI: 10.1024/1661-8157/a003649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Overall, heart patients should be advised individually with respect to their tolerance of altitudes. However, the historical reflex that altitude 'per se' is bad for heart patients should become a thing of the past. Adequately treated and stable patients can usually go up to an altitude of 2500 m without any restrictions. Higher altitudes are also possible for a large number of patients, but may require an adaptation of the medication and further clarification. This is especially the case when physical work is to be performed at great heights.
Collapse
|
8
|
Agostoni P, Sciomer S, Palermo P, Contini M, Pezzuto B, Farina S, Magini A, De Martino F, Magrì D, Paolillo S, Cattadori G, Vignati C, Mapelli M, Apostolo A, Salvioni E. Minute ventilation/carbon dioxide production in chronic heart failure. Eur Respir Rev 2021; 30:30/159/200141. [PMID: 33536259 PMCID: PMC9489123 DOI: 10.1183/16000617.0141-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/21/2020] [Indexed: 11/05/2022] Open
Abstract
In chronic heart failure, minute ventilation (V'E) for a given carbon dioxide production (V'CO2 ) might be abnormally high during exercise due to increased dead space ventilation, lung stiffness, chemo- and metaboreflex sensitivity, early metabolic acidosis and abnormal pulmonary haemodynamics. The V'E versus V'CO2 relationship, analysed either as ratio or as slope, enables us to evaluate the causes and entity of the V'E/perfusion mismatch. Moreover, the V'E axis intercept, i.e. when V'CO2 is extrapolated to 0, embeds information on exercise-induced dead space changes, while the analysis of end-tidal and arterial CO2 pressures provides knowledge about reflex activities. The V'E versus V'CO2 relationship has a relevant prognostic power either alone or, better, when included within prognostic scores. The V'E versus V'CO2 slope is reported as an absolute number with a recognised cut-off prognostic value of 35, except for specific diseases such as hypertrophic cardiomyopathy and idiopathic cardiomyopathy, where a lower cut-off has been suggested. However, nowadays, it is more appropriate to report V'E versus V'CO2 slope as percentage of the predicted value, due to age and gender interferences. Relevant attention is needed in V'E versus V'CO2 analysis in the presence of heart failure comorbidities. Finally, V'E versus V'CO2 abnormalities are relevant targets for treatment in heart failure.
Collapse
Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy .,Dept of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Susanna Sciomer
- Dept of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | - Damiano Magrì
- Dept of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Paolillo
- Dept of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Gaia Cattadori
- Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milan, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Dept of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Dept of Clinical Science and Community Health, University of Milan, Milan, Italy
| | | | | |
Collapse
|
9
|
Ji Q, Zhang Y, Zhang H, Liu J, Cao C, Yuan Z, Ma Q, Zhang W. Effects of β-adrenoceptor activation on haemodynamics during hypoxic stress in rats. Exp Physiol 2020; 105:1660-1668. [PMID: 32706493 DOI: 10.1113/ep088669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? The acute hypoxic compensatory reaction is based on haemodynamic changes, and β-adrenoceptors are involved in haemodynamic regulation. What is the role of β-adrenoceptors in haemodynamics during hypoxic exposure? What is the main finding and its importance? Activation of β2 -adrenoceptors attenuates the increase in pulmonary artery pressure during hypoxic exposure. This compensatory reaction activated by β2 -adrenoceptors during hypoxic stress is very important to maintain the activities of normal life. ABSTRACT The acute hypoxic compensatory reaction is accompanied by haemodynamic changes. We monitored the haemodynamic changes in rats undergoing acute hypoxic stress and applied antagonists of β-adrenoceptor (β-ARs) subtypes to reveal the regulatory role of β-ARs on haemodynamics. Sprague-Dawley rats were randomly divided into control, atenolol (β1 -AR antagonist), ICI 118,551 (β2 -AR antagonist) and propranolol (non-selective β-AR antagonist) groups. Rats were continuously recorded for changes in haemodynamic indexes for 10 min after administration. Then, a hypoxic ventilation experiment [15% O2 , 2200 m a.sl., 582 mmHg (0.765 Pa), P O 2 87.3 mmHg; Xining, China] was conducted, and the indexes were monitored for 5 min after induction of hypoxia. Plasma catecholamine concentrations were also measured. We found that, during normoxia, the mean arterial pressure, heart rate, ascending aortic blood flow and pulmonary artery pressure were reduced in the propranolol and atenolol groups. Catecholamine concentrations were increased significantly in the atenolol group compared with the control group. During hypoxia, mean arterial pressure and total peripheral resistance were decreased in the control, propranolol and ICI 118,551 groups. Pulmonary arterial pressure and pulmonary vascular resistance were increased in the propranolol and ICI 118,551 groups. During hypoxia, catecholamine concentrations were increased significantly in the control group, but decreased in β-AR antagonist groups. In conclusion, the β2 -AR is involved in regulation of pulmonary haemodynamics in the acute hypoxic compensatory reaction, and the activation of β2 -ARs attenuates the increase in pulmonary arterial pressure during hypoxic stress. This compensatory reaction activated by β2 -ARs during hypoxic stress is very important to maintain activities of normal life.
Collapse
Affiliation(s)
- Qiaorong Ji
- Department of Basic Medicine, Medical College of Qinghai University, No.16 kunlun road, Xining, Qinghai, 810001, China.,Pathophysiology Laboratory, The Key Laboratory of Science and Technology for High Altitude Medicine, No.16 kunlun road, Xining, Qinghai, 810001, China
| | - Yu Zhang
- Department of Basic Medicine, Medical College of Qinghai University, No.16 kunlun road, Xining, Qinghai, 810001, China
| | - Huan Zhang
- Department of Pathology, Weinan Central Hospital, Shengli street, Weinan, Shaanxi, 714000, China
| | - Jie Liu
- Department of Basic Medicine, Medical College of Qinghai University, No.16 kunlun road, Xining, Qinghai, 810001, China.,Pathophysiology Laboratory, The Key Laboratory of Science and Technology for High Altitude Medicine, No.16 kunlun road, Xining, Qinghai, 810001, China
| | - Chengzhu Cao
- Department of Basic Medicine, Medical College of Qinghai University, No.16 kunlun road, Xining, Qinghai, 810001, China.,Pathophysiology Laboratory, The Key Laboratory of Science and Technology for High Altitude Medicine, No.16 kunlun road, Xining, Qinghai, 810001, China
| | - Zhouyang Yuan
- Department of Basic Medicine, Medical College of Qinghai University, No.16 kunlun road, Xining, Qinghai, 810001, China.,Pathophysiology Laboratory, The Key Laboratory of Science and Technology for High Altitude Medicine, No.16 kunlun road, Xining, Qinghai, 810001, China
| | - Qianqian Ma
- Department of Basic Medicine, Medical College of Qinghai University, No.16 kunlun road, Xining, Qinghai, 810001, China.,Pathophysiology Laboratory, The Key Laboratory of Science and Technology for High Altitude Medicine, No.16 kunlun road, Xining, Qinghai, 810001, China
| | - Wei Zhang
- Department of Basic Medicine, Medical College of Qinghai University, No.16 kunlun road, Xining, Qinghai, 810001, China.,Pathophysiology Laboratory, The Key Laboratory of Science and Technology for High Altitude Medicine, No.16 kunlun road, Xining, Qinghai, 810001, China
| |
Collapse
|
10
|
Sinagra G, Corrà U, Contini M, Magrì D, Paolillo S, Perrone Filardi P, Sciomer S, Badagliacca R, Agostoni P. Choosing among β-blockers in heart failure patients according to β-receptors' location and functions in the cardiopulmonary system. Pharmacol Res 2020; 156:104785. [PMID: 32224252 DOI: 10.1016/j.phrs.2020.104785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
Several large clinical trials showed a favorable effect of β-blocker treatment in patients with chronic heart failure (HF) as regards overall mortality, cardiovascular mortality, and hospitalizations. Indeed, the use of β-blockers is strongly recommended by current international guidelines, and it remains a cornerstone in the pharmacological treatment of HF. Although different types of β-blockers are currently approved for HF therapy, possible criteria to choose the best β-blocking agent according to HF patients' characteristics and to β-receptors' location and functions in the cardiopulmonary system are still lacking. In such a context, a growing body of literature shows remarkable differences between β-blocker types (β1-selective blockers versus β1-β2 blockers) with respect to alveolar-capillary gas diffusion and chemoreceptor response in HF patients, both factors able to impact on quality of life and, most likely, on prognosis. This review suggests an original algorithm for choosing among the currently available β-blocking agents based on the knowledge of cardiopulmonary pathophysiology. Particularly, starting from lung physiology and from some experimental models, it focuses on the mechanisms underlying lung mechanics, chemoreceptors, and alveolar-capillary unit impairment in HF. This paper also remarks the significant benefit deriving from the correct use of the different β-blockers in HF patients through a brief overview of the most important clinical trials.
Collapse
Affiliation(s)
- Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, Veruno Institute, Veruno, Italy
| | | | - Damiano Magrì
- Department of Clinical and Molecular Medicine, "Sapienza" Università Degli Studi Di Roma, Roma, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | | | - Susanna Sciomer
- Dipartimento Di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza" Università Degli Studi Di Roma, Roma, Italy
| | - Roberto Badagliacca
- Dipartimento Di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza" Università Degli Studi Di Roma, Roma, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
| |
Collapse
|
11
|
Niebauer JH, Niebauer J, Wille M, Burtscher M. Systemic Blood Pressure Variation During a 12-Hour Exposure to Normobaric Hypoxia (4500 m). High Alt Med Biol 2020; 21:194-199. [PMID: 32186921 DOI: 10.1089/ham.2019.0130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study was aimed at evaluating a potential association between blood pressure variation and acute mountain sickness (AMS) during acute exposure to normobaric hypoxia. A total of 77 healthy subjects (43 males, 34 females) were exposed to a simulated altitude of 4500 m for 12 hours. Peripheral oxygen saturation, heart rate, systemic blood pressure, and Lake Louise AMS scores were recorded before and during (30 minutes, 3, 6, 9, and 12 hours) hypoxic exposure. Blood pressure dips were observed at 3-hour mark. However, systolic blood pressure fell more pronounced from baseline during the initial 30 minutes in normobaric hypoxia (-17.5 vs. -11.0 mmHg, p = 0.01) in subjects suffering from AMS (AMS+; n = 56) than in those remaining unaffected from AMS (AMS-; n = 21); values did not differ between groups over the subsequent time course. Our data may suggest a transient autonomic dysfunction resulting in a more pronounced blood pressure drop during initial hypoxic exposure in AMS+ compared with AMS- subjects.
Collapse
Affiliation(s)
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Maria Wille
- Department of Sports Science, University of Innsbruck, Innsbruck, Austria
| | - Martin Burtscher
- Department of Sports Science, University of Innsbruck, Innsbruck, Austria.,Austrian Society for Alpine- and High-Altitude Medicine, Innsbruck, Austria
| |
Collapse
|
12
|
Parati G, Agostoni P, Basnyat B, Bilo G, Brugger H, Coca A, Festi L, Giardini G, Lironcurti A, Luks AM, Maggiorini M, Modesti PA, Swenson ER, Williams B, Bärtsch P, Torlasco C. Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions: A joint statement by the European Society of Cardiology, the Council on Hypertension of the European Society of Cardiology, the European Society of Hypertension, the International Society of Mountain Medicine, the Italian Society of Hypertension and the Italian Society of Mountain Medicine. Eur Heart J 2019; 39:1546-1554. [PMID: 29340578 PMCID: PMC5930248 DOI: 10.1093/eurheartj/ehx720] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 12/15/2017] [Indexed: 01/22/2023] Open
Abstract
Adapted from Bärtsch and Gibbs2 Physiological response to hypoxia. Life-sustaining oxygen delivery, in spite of a reduction in the partial pressure of inhaled oxygen between 25% and 60% (respectively at 2500 m and 8000 m), is ensured by an increase in pulmonary ventilation, an increase in cardiac output by increasing heart rate, changes in vascular tone, as well as an increase in haemoglobin concentration. BP, blood pressure; HR, heart rate; PaCO2, partial pressure of arterial carbon dioxide. ![]()
Collapse
Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Piergiuseppe Agostoni
- Department of Cardiology, Heart Failure Unit, Centro Cardiologico Monzino, via Parea 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, via Festa del Perdono 7, 20122 Milan, Italy
| | - Buddha Basnyat
- Nuffield Department of Clinical Medicine, Oxford University Clinical Research Unit-Nepal and Centre for Tropical Medicine and Global Health, University of Oxford, Old Road campus, Roosevelt Drive, Headington, Oxford OX3 7FZ, UK
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine at the EURAC Research, viale Druso 1, 39100 Bolzano, Italy.,Medical University, Christoph-Probst-Platz 1, Innrain 52 A - 6020 Innsbruck, Austria
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Luigi Festi
- Surgery Department, Ospedale di Circolo Fondazione Macchi, viale Luigi Borri, 57, 21100 Varese, Italy.,University of Insubria, via Ravasi 2, 21100 Varese, Italy
| | - Guido Giardini
- Department of Neurology, Neurophysiopathology Unit, Valle d'Aosta Regional Hospital, via Ginevra, 3, 11100 Aosta, Italy
| | - Alessandra Lironcurti
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy
| | - Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, 98195 WA, USA
| | - Marco Maggiorini
- Medical Intensive Care Unit, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Pietro A Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134 Florence, Florence, Italy
| | - Erik R Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, 98195 WA, USA.,Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, 98108 WA, USA
| | - Bryan Williams
- University College London (UCL) and NIHR UCL Hospitals Biomedical Research Centre, NHS Foundation Trust, University College, Gower St, Bloomsbury, London WC1E 6BT, UK
| | - Peter Bärtsch
- Department of Internal Medicine, University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy
| |
Collapse
|
13
|
Narvaez-Guerra O, Herrera-Enriquez K, Medina-Lezama J, Chirinos JA. Systemic Hypertension at High Altitude. Hypertension 2019; 72:567-578. [PMID: 30354760 DOI: 10.1161/hypertensionaha.118.11140] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Offdan Narvaez-Guerra
- From the Santa María Catholic University and PREVENCION Research Institute, Arequipa, Peru (O.N.-G., K.H.-E., J.M.-L.)
| | - Karela Herrera-Enriquez
- From the Santa María Catholic University and PREVENCION Research Institute, Arequipa, Peru (O.N.-G., K.H.-E., J.M.-L.)
| | - Josefina Medina-Lezama
- From the Santa María Catholic University and PREVENCION Research Institute, Arequipa, Peru (O.N.-G., K.H.-E., J.M.-L.)
| | - Julio A Chirinos
- University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia (J.A.C.)
| |
Collapse
|
14
|
Caravita S, Faini A, Baratto C, Bilo G, Macarlupu JL, Lang M, Revera M, Lombardi C, Villafuerte FC, Agostoni P, Parati G. Upward Shift and Steepening of the Blood Pressure Response to Exercise in Hypertensive Subjects at High Altitude. J Am Heart Assoc 2018; 7:e008506. [PMID: 29886423 PMCID: PMC6220550 DOI: 10.1161/jaha.117.008506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute exposure to high-altitude hypobaric hypoxia induces a blood pressure rise in hypertensive humans, both at rest and during exercise. It is unclear whether this phenomenon reflects specific blood pressure hyperreactivity or rather an upward shift of blood pressure levels. We aimed at evaluating the extent and rate of blood pressure rise during exercise in hypertensive subjects acutely exposed to high altitude, and how these alterations can be counterbalanced by antihypertensive treatment. METHODS AND RESULTS Fifty-five subjects with mild hypertension, double-blindly randomized to placebo or to a fixed-dose combination of an angiotensin-receptor blocker (telmisartan 80 mg) and a calcium-channel blocker (nifedipine slow release 30 mg), performed a cardiopulmonary exercise test at sea level and after the first night's stay at 3260 m altitude. High-altitude exposure caused both an 8 mm Hg upward shift (P<0.01) and a 0.4 mm Hg/mL/kg per minute steepening (P<0.05) of the systolic blood pressure/oxygen consumption relationship during exercise, independent of treatment. Telmisartan/nifedipine did not modify blood pressure reactivity to exercise (blood pressure/oxygen consumption slope), but downward shifted (P<0.001) the relationship between systolic blood pressure and oxygen consumption by 26 mm Hg, both at sea level and at altitude. Muscle oxygen delivery was not influenced by altitude exposure but was higher on telmisartan/nifedipine than on placebo (P<0.01). CONCLUSIONS In hypertensive subjects exposed to high altitude, we observed a hypoxia-driven upward shift and steepening of the blood pressure response to exercise. The effect of the combination of telmisartan/nifedipine slow release outweighed these changes and was associated with better muscle oxygen delivery. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01830530.
Collapse
Affiliation(s)
- Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Claudia Baratto
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Josè Luis Macarlupu
- Laboratorio de Fisiologia Comparada, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Morin Lang
- Department de Ciencias de la Rehabilitación y del Movimiento Humano, Universidad de Antofagasta, Chile
| | - Miriam Revera
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carolina Lombardi
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francisco C Villafuerte
- Laboratorio de Fisiologia Comparada, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
15
|
Abstract
Cardiopulmonary exercise testing (CPET) in hyperoxia and hypoxia has several applications, stemming from characterization of abnormal physiological response profiles associated with exercise intolerance. As altered oxygenation can impact the performance of gas-concentration and flow sensors and pulmonary gas exchange algorithms, integrated CPET system function requires validation under these conditions. Also, as oxygenation status can influence peak [Formula: see text]o2, care should be taken in the selection of work-rate incrementation rates when CPET performance is to be compared with normobaria at sea level. CPET has been used to evaluate the effects of supplemental O2 on exercise intolerance in chronic obstructive pulmonary disease, interstitial pulmonary fibrosis, and cystic fibrosis at sea level. However, identification of those CPET indices likely to be predictive of supplemental O2 outcomes for exercise tolerance at altitude in such patients is lacking. CPET performance with supplemental O2 in respiratory patients residing at high altitudes is also poorly studied. Finally, CPET has the potential to give physiological and clinical information about acute and chronic mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. It may also translate high-altitude acclimatization and adaptive processes in healthy individuals into intensive care medical practice.
Collapse
|
16
|
Donegani E, Paal P, Küpper T, Hefti U, Basnyat B, Carceller A, Bouzat P, van der Spek R, Hillebrandt D. Drug Use and Misuse in the Mountains: A UIAA MedCom Consensus Guide for Medical Professionals. High Alt Med Biol 2016; 17:157-184. [PMID: 27583821 DOI: 10.1089/ham.2016.0080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Donegani, Enrico, Peter Paal, Thomas Küpper, Urs Hefti, Buddha Basnyat, Anna Carceller, Pierre Bouzat, Rianne van der Spek, and David Hillebrandt. Drug use and misuse in the mountains: a UIAA MedCom consensus guide for medical professionals. High Alt Med Biol. 17:157-184, 2016.-Aims: The aim of this review is to inform mountaineers about drugs commonly used in mountains. For many years, drugs have been used to enhance performance in mountaineering. It is the UIAA (International Climbing and Mountaineering Federation-Union International des Associations d'Alpinisme) Medcom's duty to protect mountaineers from possible harm caused by uninformed drug use. The UIAA Medcom assessed relevant articles in scientific literature and peer-reviewed studies, trials, observational studies, and case series to provide information for physicians on drugs commonly used in the mountain environment. Recommendations were graded according to criteria set by the American College of Chest Physicians. RESULTS Prophylactic, therapeutic, and recreational uses of drugs relevant to mountaineering are presented with an assessment of their risks and benefits. CONCLUSIONS If using drugs not regulated by the World Anti-Doping Agency (WADA), individuals have to determine their own personal standards for enjoyment, challenge, acceptable risk, and ethics. No system of drug testing could ever, or should ever, be policed for recreational climbers. Sponsored climbers or those who climb for status need to carefully consider both the medical and ethical implications if using drugs to aid performance. In some countries (e.g., Switzerland and Germany), administrative systems for mountaineering or medication control dictate a specific stance, but for most recreational mountaineers, any rules would be unenforceable and have to be a personal decision, but should take into account the current best evidence for risk, benefit, and sporting ethics.
Collapse
Affiliation(s)
- Enrico Donegani
- 1 Department of Cardiovascular Surgery, Sabah Al-Ahmed Cardiac Center , Al-Amiri Hospital, Kuwait, State of Kuwait
| | - Peter Paal
- 2 Department of Anaesthesiology and Critical Care Medicine, Innsbruck University Hospital , Innsbruck, Austria .,3 Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, United Kingdom .,4 Perioperative Medicine, St. Bartholomew's Hospital , London, United Kingdom
| | - Thomas Küpper
- 5 Institute of Occupational and Social Medicine, RWTH Aachen University , Aachen, Germany
| | - Urs Hefti
- 6 Department of Orthopedic and Trauma Surgery, Swiss Sportclinic , Bern, Switzerland
| | - Buddha Basnyat
- 7 Oxford University Clinical Research Unit-Nepal , Nepal International Clinic, and Himalayan Rescue, Kathmandu, Nepal
| | - Anna Carceller
- 8 Sports Medicine School, Instituto de Medicina de Montaña y del Deporte (IMMED), Federació d'Entitats Excursionistes (FEEC), University of Barcelona , Barcelona, Spain
| | - Pierre Bouzat
- 9 Department of Anesthesiology and Critical Care, University Hospital, INSERM U1236, Neuroscience Institute, Alps University, Grenoble, France
| | - Rianne van der Spek
- 10 Department of Endocrinology and Metabolism, Academic Medical Center Amsterdam, University of Amsterdam , Amsterdam, The Netherlands
| | | |
Collapse
|
17
|
Lang M, Faini A, Caravita S, Bilo G, Anza-Ramìrez C, Villafuerte FC, Macarlupu JL, Salvioni E, Agostoni P, Parati G. Blood pressure response to six-minute walk test in hypertensive subjects exposed to high altitude: effects of antihypertensive combination treatment. Int J Cardiol 2016; 219:27-32. [DOI: 10.1016/j.ijcard.2016.04.169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
|
18
|
Abstract
BACKGROUND AND AIMS Altitude-related medical literature provides very few simple clinical studies relating to those on 'adventure holidays'. Systemic blood pressure has seldom been studied closely in relation to altitude. This study aimed to address both these issues and to assist GPs approached by patients for pre-trek advice. METHODS AND RESULTS A total of 17 hillwalkers, evenly distributed for gender and age, trekked gradually from moderate to extreme altitude on Mera Peak in the Himalaya, noting any altitude sickness symptoms. Heart rate, blood pressure, oxygen saturation, peak expiratory flow and core temperature were measured daily. Altitude was double-checked hourly and synchronised with each set of measurements. On each day, two individuals wore 24-h ambulatory blood pressure monitors for assessment of altitude effects. Two principal findings emerged. Firstly, none of our 17 developed altitude-related symptoms below 4000 m, consistent with the recognised protective effect of slow rate of ascent; at 3500-4000 m all showed a sharp fall on O2sat and above 4500 m symptoms arose unpredictably. Secondly, hourly blood pressure monitoring showed no altitude effect below 3500 m, but above 5000 m a marked yet asymptomatic rise with delayed and prolonged peak. CONCLUSION There may be a critical altitude above which extra vigilance is required; blood pressure here needs further research.
Collapse
|
19
|
Parati G, Ochoa JE, Torlasco C, Salvi P, Lombardi C, Bilo G. Aging, High Altitude, and Blood Pressure: A Complex Relationship. High Alt Med Biol 2015; 16:97-109. [DOI: 10.1089/ham.2015.0010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Gianfranco Parati
- Cardiovascular Medicine, Department of Health Sciences, University of Milan-Bicocca, Milan, Italy
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Juan Eugenio Ochoa
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Camilla Torlasco
- Cardiovascular Medicine, Department of Health Sciences, University of Milan-Bicocca, Milan, Italy
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Salvi
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carolina Lombardi
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| |
Collapse
|
20
|
Bilo G, Villafuerte FC, Faini A, Anza-Ramírez C, Revera M, Giuliano A, Caravita S, Gregorini F, Lombardi C, Salvioni E, Macarlupu JL, Ossoli D, Landaveri L, Lang M, Agostoni P, Sosa JM, Mancia G, Parati G. Ambulatory Blood Pressure in Untreated and Treated Hypertensive Patients at High Altitude. Hypertension 2015; 65:1266-72. [DOI: 10.1161/hypertensionaha.114.05003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/27/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Grzegorz Bilo
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Francisco C. Villafuerte
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Andrea Faini
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Cecilia Anza-Ramírez
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Miriam Revera
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Andrea Giuliano
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Sergio Caravita
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Francesca Gregorini
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Carolina Lombardi
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Elisabetta Salvioni
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Jose Luis Macarlupu
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Deborah Ossoli
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Leah Landaveri
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Morin Lang
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Piergiuseppe Agostoni
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - José Manuel Sosa
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Giuseppe Mancia
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| | - Gianfranco Parati
- From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS,
| |
Collapse
|
21
|
Velasco A, Vongpatanasin W, Levine BD. Treating hypertension at high altitude: the quest for a magic bullet continues. Eur Heart J 2014; 35:3083-4. [DOI: 10.1093/eurheartj/ehu366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Parati G, Bilo G, Faini A, Bilo B, Revera M, Giuliano A, Lombardi C, Caldara G, Gregorini F, Styczkiewicz K, Zambon A, Piperno A, Modesti PA, Agostoni P, Mancia G. Changes in 24 h ambulatory blood pressure and effects of angiotensin II receptor blockade during acute and prolonged high-altitude exposure: a randomized clinical trial. Eur Heart J 2014; 35:3113-22. [DOI: 10.1093/eurheartj/ehu275] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
|
23
|
Howlett JG. Nebivolol: vasodilator properties and evidence for relevance in treatment of cardiovascular disease. Can J Cardiol 2014; 30:S29-37. [PMID: 24750980 DOI: 10.1016/j.cjca.2014.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 12/31/2022] Open
Abstract
β-adrenergic blocking agents, a pharmacologically diverse class of cardiovascular medications, are recommended as first-line treatment for patients with hypertension and concomitant structural heart disease, and for angina and heart failure. Many within-class differences exist, from pharmacokinetics and pharmacodynamics to ancillary effects, such as intrinsic sympathomimetic activity, antiarrhythmic activity, α-1 adrenergic receptor blockade affinity, and direct vasodilation. Nebivolol is a third-generation, β1 selective, long acting β-blocker, which causes direct vasodilation via endothelium-dependent nitric oxide stimulation. The vasodilatory actions of nebivolol might result in clinical effects with some distinct properties. Differences from other β-blockers might include improvement of endothelial function, enhancement of forward flow in muscular resistance arteries, maintenance of exercise tolerance, and overall improved tolerability, side effect profile, and adherence. Nebivolol has been shown to be a clinically effective β-blocker for treatment as initial or add-on therapy for systemic hypertension, as an antianginal agent, and as therapy for patients with heart failure. These properties position nebivolol as a treatment option for patients with hypertension and/or structural heart disease, although its precise role in the therapeutic armamentarium remains to be clarified.
Collapse
Affiliation(s)
- Jonathan G Howlett
- Department of Medicine, University of Calgary and Libin Cardiovascular Institute, Calgary, Alberta, Canada.
| |
Collapse
|
24
|
Gargiulo P, Olla S, Boiti C, Contini M, Perrone-Filardi P, Agostoni P. Predicted values of exercise capacity in heart failure: where we are, where to go. Heart Fail Rev 2013; 19:645-53. [DOI: 10.1007/s10741-013-9403-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
25
|
Agostoni P. Considerations on Safety and Treatment of Patients with Chronic Heart Failure at High Altitude. High Alt Med Biol 2013; 14:96-100. [DOI: 10.1089/ham.2012.1117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Dipartimento di scienze cliniche e di comunità, Università di Milano, Milan Italy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
26
|
Contini M, Apostolo A, Cattadori G, Paolillo S, Iorio A, Bertella E, Salvioni E, Alimento M, Farina S, Palermo P, Loguercio M, Mantegazza V, Karsten M, Sciomer S, Magrì D, Fiorentini C, Agostoni P. Multiparametric comparison of CARvedilol, vs. NEbivolol, vs. BIsoprolol in moderate heart failure: the CARNEBI trial. Int J Cardiol 2013; 168:2134-40. [PMID: 23506636 DOI: 10.1016/j.ijcard.2013.01.277] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several β-blockers, with different pharmacological characteristics, are available for heart failure (HF) treatment. We compared Carvedilol (β1-β2-α-blocker), Bisoprolol (β1-blocker), and Nebivolol (β1-blocker, NO-releasing activity). METHODS Sixty-one moderate HF patients completed a cross-over randomized trial, receiving, for 2 months each, Carvedilol, Nebivolol, Bisoprolol (25.6 ± 12.6, 5.0 ± 2.4 and 5.0 ± 2.4 mg daily, respectively). At the end of each period, patients underwent: clinical evaluation, laboratory testing, echocardiography, spirometry (including total DLCO and membrane diffusion), O2/CO2 chemoreceptor sensitivity, constant workload, in normoxia and hypoxia (FiO2=16%), and maximal cardiopulmonary exercise test. RESULTS No significant differences were observed for clinical evaluation (NYHA classification, Minnesota questionnaire), laboratory findings (including kidney function and BNP), echocardiography, and lung mechanics. DLCO was lower on Carvedilol (18.3 ± 4.8*mL/min/mmHg) compared to Nebivolol (19.9 ± 5.1) and Bisoprolol (20.0 ± 5.0) due to membrane diffusion 20% reduction (*=p<0.0001). Constant workload exercise showed in hypoxia a faster VO2 kinetic and a lower ventilation with Carvedilol. Peripheral and central sensitivity to CO2 was lower in Carvedilol while response to hypoxia was higher in Bisoprolol. Ventilation efficiency (VE/VCO2 slope) was 26.9 ± 4.1* (Carvedilol), 28.8 ± 4.0 (Nebivolol), and 29.0 ± 4.4 (Bisoprolol). Peak VO2 was 15.8 ± 3.6*mL/kg/min (Carvedilol), 16.9 ± 4.1 (Nebivolol), and 16.9 ± 3.6 (Bisoprolol). CONCLUSIONS β-Blockers differently affect several cardiopulmonary functions. Lung diffusion and exercise performance, the former likely due to lower interference with β2-mediated alveolar fluid clearance, were higher in Nebivolol and Bisoprolol. On the other hand, Carvedilol allowed a better ventilation efficiency during exercise, likely via a different chemoreceptor modulation. Results from this study represent the basis for identifying the best match between a specific β-blocker and a specific HF patient.
Collapse
|
27
|
Sightings edited by John W. Severinghaus. High Alt Med Biol 2012. [DOI: 10.1089/ham.2012.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
28
|
Radiloff DR, Zhao Y, Boico A, Wu C, Shan S, Palmer G, Hamilton K, Irwin D, Hanna G, Piantadosi CA, Schroeder T. The combination of theophylline and endothelin receptor antagonism improves exercise performance of rats under simulated high altitude. J Appl Physiol (1985) 2012; 113:1243-52. [PMID: 22898548 DOI: 10.1152/japplphysiol.01622.2011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Decreased physical performance is a well-known consequence of rapid ascent to high altitude. Hypoxic pulmonary vasoconstriction (HPV) potentially limits cardiac output and systemic blood flow, thus preventing successful adaptation to rapid ascent. We hypothesized that pharmacological enhancement of the heart rate with theophylline, combined with reversal of HPV via endothelin blockade, could increase exercise performance at high altitude. Female Sprague-Dawley rats were treated with combinations of 1) theophylline, 2) the endothelin receptor antagonists sitaxsentan/ambrisentan, and/or 3) phosphodiesterase-5 inhibitor sildenafil and exposed to either a simulated high altitude (4,267 m) or 12% oxygen. Exercise capacity, peripheral blood flow, hemodynamics, and pulmonary leak were examined. Combination treatment with theophylline and endothelin blockade, but not with the respective single compounds, significantly prolonged run-to-fatigue time under simulated high altitude. No such efficacy was found when theophylline was combined with sildenafil. Neither theophylline nor sitaxsentan or their combination influenced breathing rates and hemoglobin oxygen saturation. Whereas under hypoxia, theophylline significantly increased muscular blood flow, and sitaxsentan increased tissue oxygenation, the combination improved both parameters but in a reduced manner. Under hypoxia, the combination treatment but not the single compounds significantly enhanced pulmonary arterial pressure compared with controls (13.1 ± 6.3 vs. 11.9 ± 5.2 mmHg), whereas mean arterial pressure remained unaffected. Pulmonary wet-to-dry weight ratios were unaffected by combination treatment. We conclude that concomitant dosing with a cardiac stimulant and endothelin antagonist can partially reverse loss of physical performance capacity under hypobaric hypoxia, independent from improving blood oxygen saturation.
Collapse
Affiliation(s)
- Daniel R Radiloff
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Toblli JE, DiGennaro F, Giani JF, Dominici FP. Nebivolol: impact on cardiac and endothelial function and clinical utility. Vasc Health Risk Manag 2012; 8:151-60. [PMID: 22454559 PMCID: PMC3310359 DOI: 10.2147/vhrm.s20669] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Endothelial dysfunction is a systemic pathological state of the endothelium characterized by a reduction in the bioavailability of vasodilators, essentially nitric oxide, leading to impaired endothelium-dependent vasodilation, as well as disarrangement in vascular wall metabolism and function. One of the key factors in endothelial dysfunction is overproduction of reactive oxygen species which participate in the development of hypertension, atherosclerosis, diabetes, cardiac hypertrophy, heart failure, ischemia-reperfusion injury, and stroke. Because impaired endothelial activity is believed to have a major causal role in the pathophysiology of vascular disease, hypertension, and heart failure, therapeutic agents which modify this condition are of clinical interest. Nebivolol is a third-generation β-blocker with high selectivity for β1-adrenergic receptors and causes vasodilation by interaction with the endothelial L-arginine/ nitric oxide pathway. This dual mechanism of action underscores several hemodynamic qualities of nebivolol, which include reductions in heart rate and blood pressure and improvements in systolic and diastolic function. Although nebivolol reduces blood pressure to a degree similar to that of conventional β-blockers and other types of antihypertensive drugs, it may have advantages in populations with difficult-to-treat hypertension, such as patients with heart failure along with other comorbidities, like diabetes and obesity, and elderly patients in whom nitric oxide-mediated endothelial dysfunction may be more pronounced. Furthermore, recent data indicate that nebivolol appears to be a cost-effective treatment for elderly patients with heart failure compared with standard care. Thus, nebivolol is an effective and well tolerated agent with benefits above those of traditional β-blockers due to its influence on nitric oxide release, which give it singular hemodynamic effects, cardioprotective activity, and a good tolerability profile. This paper reviews the pharmacology structure and properties of nebivolol, focusing on endothelial dysfunction, clinical utility, comparative efficacy, side effects, and quality of life in general with respect to the other antihypertensive agents.
Collapse
|