Keyes Linda E, Sallade Thomas Douglas, Duke Charles, Starling Jennifer, Sheets Alison, Pant Sushil, Young David S, Twillman David, Regmi Nirajan, Phelan Benoit, Paudel Purshotam, McElwee Matthew, Mather Luke, Cole Devlin, McConnell Theodore, Basnyat Buddha
1 Department of Emergency Medicine, University of Colorado , Aurora, Colorado.
2 Longmont United Hospital , Longmont, Colorado.
High Alt Med Biol. 2017 Sep;18(3):267-277. doi: 10.1089/ham.2017.0001. Epub 2017 Aug 8.
Keyes, Linda E., Thomas Douglas Sallade, Charles Duke, Jennifer Starling, Alison Sheets, Sushil Pant, David S. Young, David Twillman, Nirajan Regmi, Benoit Phelan, Purshotam Paudel, Matthew McElwee, Luke Mather, Devlin Cole, Theodore McConnell, and Buddha Basnyat. Blood pressure and altitude: an observational cohort study of hypertensive and nonhypertensive Himalayan trekkers in Nepal. High Alt Med Biol. 18:267-277, 2017.
To determine how blood pressure (BP) changes with altitude in normotensive versus hypertensive trekkers. Secondary aims were to evaluate the prevalence of severe hypertension (BP ≥180/100 mmHg) and efficacy of different antihypertensive agents at high altitude.
This was an observational cohort study of resting and 24-hour ambulatory BP in normotensive and hypertensive trekkers at 2860, 3400, and 4300 m in Nepal.
We enrolled 672 trekkers age 18 years and older, 60 with a prior diagnosis of hypertension. Mean systolic and diastolic BP did not change between altitudes in normotensive or hypertensive trekkers, but was higher in those with hypertension. However, there was large interindividual variability. At 3400 m, the majority (60%, n = 284) of normotensive participants had a BP within 10 mmHg of their BP at 2860 m, while 21% (n = 102) increased and 19% (n = 91) decreased. The pattern was similar between 3400 and 4300 m (64% [n = 202] no change, 21% [n = 65] increased, 15% [n = 46] decreased). BP decreased in a greater proportion of hypertensive trekkers versus normotensives (36% [n = 15] vs. 21% at 3400 m, p = 0.01 and 30% [n = 7] vs. 15% at 4300 m, p = 0.05). Severe hypertension occurred in both groups, but was asymptomatic. In a small subset of participants, 24-hour ambulatory BP monitoring showed that nocturnal BP decreased in normotensive (n = 4) and increased in hypertensive trekkers (n = 4).
Most travelers, including those with well-controlled hypertension, can be reassured that their BP will remain relatively stable at high altitude. Although extremely elevated BP may be observed at high altitude in normotensive and hypertensive people, it is unlikely to be symptomatic. The ideal antihypertensive regimen at high altitude remains unclear.
凯斯，琳达·E.，托马斯·道格拉斯·萨拉德，查尔斯·杜克，詹妮弗·斯塔林，艾莉森·希茨，苏希尔·潘特，大卫·S. 杨，大卫·特威尔曼，尼拉詹·雷格米，伯努瓦·费伦，普尔肖坦·保德尔，马修·麦克尔维，卢克·马瑟，德夫林·科尔，西奥多·麦康奈尔，以及布达·巴斯尼亚特。血压与海拔高度：尼泊尔喜马拉雅徒步旅行者中高血压和非高血压人群的一项观察性队列研究。《高海拔医学与生物学》。18:267 - 277，2017年。
确定血压正常与高血压的徒步旅行者的血压随海拔高度如何变化。次要目标是评估重度高血压（血压≥180/100 mmHg）的患病率以及不同抗高血压药物在高海拔地区的疗效。
这是一项对尼泊尔海拔2860米、3400米和4300米处血压正常和高血压徒步旅行者的静息血压及24小时动态血压的观察性队列研究。
我们招募了672名18岁及以上的徒步旅行者，其中60人先前被诊断患有高血压。血压正常或高血压的徒步旅行者在不同海拔高度之间平均收缩压和舒张压没有变化，但高血压患者的血压更高。然而，个体间存在很大差异。在3400米处，大多数（60%，n = 284）血压正常的参与者血压与2860米处相比变化在10 mmHg以内，而21%（n = 102）升高，19%（n = 91）降低。3400米和4300米之间的模式相似（64% [n = 202] 无变化，21% [n = 65] 升高，15% [n = 46] 降低）。与血压正常者相比，高血压徒步旅行者中血压下降的比例更大（3400米处为36% [n = 15] 对21%，p = 0.01；4300米处为30% [n = 7] 对15%，p = 0.05）。两组均出现了重度高血压，但无症状。在一小部分参与者中，24小时动态血压监测显示，血压正常的徒步旅行者（n = 4）夜间血压下降，高血压徒步旅行者（n = 4）夜间血压升高。
大多数旅行者，包括那些高血压控制良好的人，可以放心他们的血压在高海拔地区将保持相对稳定。尽管在高海拔地区血压正常和高血压人群中可能会观察到血压极度升高，但不太可能有症状。高海拔地区理想的抗高血压治疗方案仍不明确。
