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Duo D, Duan Y, Zhu J, Bai X, Yang J, Liu G, Wang Q, Li X. New strategy for rational use of antihypertensive drugs in clinical practice in high-altitude hypoxic environments. Drug Metab Rev 2023; 55:388-404. [PMID: 37606301 DOI: 10.1080/03602532.2023.2250930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
High-altitude hypoxic environments have critical implications on cardiovascular system function as well as blood pressure regulation. Such environments place patients with hypertension at risk by activating the sympathetic nervous system, which leads to an increase in blood pressure. In addition, the high-altitude hypoxic environment alters the in vivo metabolism and antihypertensive effects of antihypertensive drugs, which changes the activity and expression of drug-metabolizing enzymes and drug transporters. The present study reviewed the pharmacodynamics and pharmacokinetics of antihypertensive drugs and its effects on patients with hypertension in a high-altitude hypoxic environment. It also proposes a new strategy for the rational use of antihypertensive drugs in clinical practice in high-altitude hypoxic environments. The increase in blood pressure on exposure to a high-altitude hypoxic environment was mainly dependent on increased sympathetic nervous system activity. Blood pressure also increased proportionally to altitude, whilst ambulatory blood pressure increased more than conventional blood pressure, especially at night. High-altitude hypoxia can reduce the activities and expression of drug-metabolizing enzymes, such as CYP1A1, CYP1A2, CYP3A1, and CYP2E1, while increasing those of CYP2D1, CYP2D6, and CYP3A6. Drug transporter changes were related to tissue type, hypoxic degree, and hypoxic exposure time. Furthermore, the effects of high-altitude hypoxia on drug-metabolism enzymes and transporters altered drug pharmacokinetics, causing changes in pharmacodynamic responses. These findings suggest that high-altitude hypoxic environments affect the blood pressure, pharmacokinetics, and pharmacodynamics of antihypertensive drugs. The optimal hypertension treatment plan and safe and effective medication strategy should be formulated considering high-altitude hypoxic environments.
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Affiliation(s)
- Delong Duo
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
- Qinghai Provincial People's Hospital, Xining, China
| | - Yabin Duan
- Qinghai University Affiliated Hospital, Xining, China
| | - Junbo Zhu
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Xue Bai
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Jianxin Yang
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Guiqin Liu
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Qian Wang
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Xiangyang Li
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining, China
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Chen R, Ye X, Sun M, Yang J, Zhang J, Gao X, Liu C, Ke J, He C, Yuan F, Lv H, Yang Y, Cheng R, Tan H, Huang L. Blood Pressure Load: An Effective Indicator of Systemic Circulation Status in Individuals With Acute Altitude Sickness. Front Cardiovasc Med 2022; 8:765422. [PMID: 35047574 PMCID: PMC8761955 DOI: 10.3389/fcvm.2021.765422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/13/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Acute high altitude (HA) exposure results in blood pressure (BP) variations in most subjects. Previous studies have demonstrated that higher BP is potentially correlated with acute mountain sickness (AMS). The BP load may be of clinical significance regarding systemic circulation status. Objectives: This study aimed to examine HA-induced BP changes in patients with AMS compared to those in healthy subjects. Further, we provided clinical information about the relationship between variations in 24-h ambulatory parameters (BP level, BP variability, and BP load) and AMS. Methods: Sixty-nine subjects were enrolled and all participants ascended Litang (4,100 m above sea level). They were monitored using a 24-h ambulatory blood pressure device and underwent echocardiography within 24 h of altitude exposure. The 2018 Lake Louise questionnaire was used to evaluate AMS. Results: The AMS group comprised more women than men [15 (65.2%) vs. 13 (28.3%), P < 0.001] and fewer smokers [4 (17.4%) vs. 23 (50.0%), P = 0.009]. The AMS group exhibited significant increases in 24-h BP compared to the non-AMS group (24-h SBP variation: 10.52 ± 6.48 vs. 6.03 ± 9.27 mmHg, P = 0.041; 24-h DBP variation: 8.70 ± 4.57 vs. 5.03 ± 4.98 mmHg, P = 0.004). The variation of mean 24-h cBPL (cumulative BP load) (mean 24-h cSBPL: 10.58 ± 10.99 vs. 4.02 ± 10.58, P = 0.016; 24-h mean cDBPL: 6.03 ± 5.87 vs. 2.89 ± 4.99, P = 0.034) was also obviously higher in AMS subjects than in non-AMS subjects after HA exposure. 24-h mean cSBPL variation (OR = 1.07, P = 0.024) and 24-h mean cDBPL variation (OR = 1.14, P = 0.034) were independent risk factors of AMS. Moreover, variation of 24-h mean cSBPL showed a good correlation with AMS score (R = 0.504, P < 0.001). Conclusions: Our study demonstrated that patients with AMS had higher BP and BP load changes after altitude exposure than healthy subjects. Excessive BP load variations were associated with AMS. Thus, BP load could be an effective indicator regarding systemic circulation status of AMS.
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Affiliation(s)
- Renzheng Chen
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaowei Ye
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Mengjia Sun
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Yang
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jihang Zhang
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xubin Gao
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chuan Liu
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingbin Ke
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chunyan He
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fangzhengyuan Yuan
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hailin Lv
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yuanqi Yang
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ran Cheng
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hu Tan
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of Chinese People's Liberation Army (PLA), The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- *Correspondence: Lan Huang
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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.
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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
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Mikołajczak K, Czerwińska K, Pilecki W, Poręba R, Gać P, Poręba M. The Impact of Temporary Stay at High Altitude on the Circulatory System. J Clin Med 2021; 10:1622. [PMID: 33921196 PMCID: PMC8068881 DOI: 10.3390/jcm10081622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
In recent times many people stay temporarily at high altitudes. It is mainly associated with the growing popularity of regular air travel, as well as temporary trips to mountain regions. Variable environmental conditions, including pressure and temperature changes, have an impact on the human body. This paper analyses the physiological changes that may occur while staying at high altitude in healthy people and in people with cardiovascular diseases, such as arterial hypertension, pulmonary hypertension, heart failure, ischemic heart disease, or arrhythmias. Possible unfavourable changes were underlined. Currently recognized treatment recommendations or possible treatment modifications for patients planning to stay at high altitudes were also discussed.
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Affiliation(s)
- Karolina Mikołajczak
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland; (K.M.); (W.P.); (M.P.)
| | - Karolina Czerwińska
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland;
| | - Witold Pilecki
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland; (K.M.); (W.P.); (M.P.)
| | - Rafał Poręba
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland;
| | - Paweł Gać
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland;
| | - Małgorzata Poręba
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland; (K.M.); (W.P.); (M.P.)
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Parati G, Caravita S. Personalized exercise prescription as a tool for hypertension management and cardiovascular prevention: evidence and pending issues. Eur J Prev Cardiol 2021; 29:202-204. [PMID: 33758929 DOI: 10.1093/eurjpc/zwab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio 7b, 24044 Dalmine (BG), Italy
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6
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Joyce KE, Delamere J, Bradwell S, Myers SD, Ashdown K, Rue C, Lucas SJ, Thomas OD, Fountain A, Edsell M, Myers F, Malein W, Imray C, Clarke A, Lewis CT, Newman C, Johnson B, Cadigan P, Wright A, Bradwell A. Hypoxia is not the primary mechanism contributing to exercise-induced proteinuria. BMJ Open Sport Exerc Med 2020; 6:e000662. [PMID: 32341794 PMCID: PMC7173992 DOI: 10.1136/bmjsem-2019-000662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Proteinuria increases at altitude and with exercise, potentially as a result of hypoxia. Using urinary alpha-1 acid glycoprotein (α1-AGP) levels as a sensitive marker of proteinuria, we examined the impact of relative hypoxia due to high altitude and blood pressure-lowering medication on post-exercise proteinuria. Methods Twenty individuals were pair-matched for sex, age and ACE genotype. They completed maximal exercise tests once at sea level and twice at altitude (5035 m). Losartan (100 mg/day; angiotensin-receptor blocker) and placebo were randomly assigned within each pair 21 days before ascent. The first altitude exercise test was completed within 24–48 hours of arrival (each pair within ~1 hour). Acetazolamide (125 mg two times per day) was administrated immediately after this test for 48 hours until the second altitude exercise test. Results With placebo, post-exercise α1-AGP levels were similar at sea level and altitude. Odds ratio (OR) for increased resting α1-AGP at altitude versus sea level was greater without losartan (2.16 times greater). At altitude, OR for reduced post-exercise α1-AGP (58% lower) was higher with losartan than placebo (2.25 times greater, p=0.059) despite similar pulse oximetry (SpO2) (p=0.95) between groups. Acetazolamide reduced post-exercise proteinuria by approximately threefold (9.3±9.7 vs 3.6±6.0 μg/min; p=0.025) although changes were not correlated (r=−0.10) with significant improvements in SpO2 (69.1%±4.5% vs 75.8%±3.8%; p=0.001). Discussion Profound systemic hypoxia imposed by altitude does not result in greater post-exercise proteinuria than sea level. Losartan and acetazolamide may attenuate post-exercise proteinuria, however further research is warranted.
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Affiliation(s)
- Kelsley E Joyce
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK
| | - John Delamere
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Susie Bradwell
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Medical School, East Surrey Hospital, Redhill, Surrey, UK
| | - Stephen David Myers
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Occupational Performance Research Group, University of Chichester Department of Sport and Exercise Sciences, Chichester, West Sussex, UK
| | - Kimberly Ashdown
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Occupational Performance Research Group, University of Chichester Department of Sport and Exercise Sciences, Chichester, West Sussex, UK
| | - Carla Rue
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Occupational Performance Research Group, University of Chichester Department of Sport and Exercise Sciences, Chichester, West Sussex, UK
| | - Samuel Je Lucas
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK
| | - Owen D Thomas
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Amy Fountain
- Research & Development, Binding Site Group Ltd, Edgbaston, Birmingham, UK
| | - Mark Edsell
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,St. George's University Hospital, University of London, London, UK
| | - Fiona Myers
- School of Biological Sciences, University of Portsmouth, Portsmouth, UK
| | - Will Malein
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Department of Anaesthesia, Ninewells Hospital, Dundee, UK
| | - Chris Imray
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Vascular Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Alex Clarke
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - Chrisopher T Lewis
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Academic Foundation Programme, NHS Highland, Inverness, United Kingdom
| | - Charles Newman
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Brian Johnson
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,BASEM, Doncaster, UK
| | - Patrick Cadigan
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK
| | - Alexander Wright
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Medical School, University of Birmingham, Birmingham, UK
| | - Arthur Bradwell
- Birmingham Medical Research Expeditionary Society, University of Birmingham, Birmingham, UK.,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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