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

Gianfranco Parati, Grzegorz Bilo, Andrea Faini, Barbara Bilo, Miriam Revera, Andrea Giuliano, Carolina Lombardi, Gianluca Caldara, Francesca Gregorini, Katarzyna Styczkiewicz, Antonella Zambon, Alberto Piperno, Pietro Amedeo Modesti, Piergiuseppe Agostoni, Giuseppe Mancia

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Aim Many hypertensive subjects travel to high altitudes, but little is known on ambulatory blood pressure (ABP) changes and antihypertensive drugs' efficacy under acute and prolonged exposure to hypobaric hypoxia. In particular, the efficacy of angiotensin receptor blockers in this condition is unknown. This may be clinically relevant considering that renin-angiotensin system activity changes at altitude. The HIGHCARE-HIMALAYA study assessed changes in 24 h ABP under acute and prolonged exposure to increasing altitude and blood pressure-lowering efficacy and safety of an angiotensin receptor blockade in this setting. Methods and results Forty-seven healthy, normotensive lowlanders were randomized to telmisartan 80 mg or placebo in a double-blind, parallel group trial. Conventional and Ambulatory BPs were measured at baseline and on treatment: after 8 weeks at sea level, and under acute exposure to 3400 and 5400 m altitude, the latter upon arrival and after 12 days (Mt. Everest base camp). Blood samples were collected for plasma catecholamines, renin, angiotensin, and aldosterone. In both groups, exposure to increasing altitude was associated with: (i) significant progressive increases in conventional and 24 h blood pressure, persisting throughout the exposure to 5400 m; (ii) increased plasma noradrenaline and suppressed renin-angiotensin-aldosterone system. Telmisartan lowered 24 h ABP at the sea level and at 3400 m (between-group difference 4.0 mmHg, 95% CI: 2.2-9.5 mmHg), but not at 5400 m. Conclusion Ambulatory blood pressure increases progressively with increasing altitude, remaining elevated after 3 weeks. An angiotensin receptor blockade maintains blood pressure-lowering efficacy at 3400 m but not at 5400 m.

Original languageEnglish
Pages (from-to)3113-3122
Number of pages10
JournalEuropean Heart Journal
Volume35
Issue number44
DOIs
Publication statusPublished - Nov 21 2014

Fingerprint

Angiotensin Receptors
Randomized Controlled Trials
Blood Pressure
Renin-Angiotensin System
Oceans and Seas
Angiotensin Receptor Antagonists
Angiotensins
Aldosterone
Renin
Antihypertensive Agents
Catecholamines
Norepinephrine
Placebos
Safety

Keywords

  • Ambulatory blood pressure monitoring
  • Angiotensin receptor blockers
  • Blood pressure
  • High altitude
  • Hypoxia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

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. / Parati, Gianfranco; Bilo, Grzegorz; Faini, Andrea; Bilo, Barbara; Revera, Miriam; Giuliano, Andrea; Lombardi, Carolina; Caldara, Gianluca; Gregorini, Francesca; Styczkiewicz, Katarzyna; Zambon, Antonella; Piperno, Alberto; Modesti, Pietro Amedeo; Agostoni, Piergiuseppe; Mancia, Giuseppe.

In: European Heart Journal, Vol. 35, No. 44, 21.11.2014, p. 3113-3122.

Research output: Contribution to journalArticle

Parati, Gianfranco ; Bilo, Grzegorz ; Faini, Andrea ; Bilo, Barbara ; Revera, Miriam ; Giuliano, Andrea ; Lombardi, Carolina ; Caldara, Gianluca ; Gregorini, Francesca ; Styczkiewicz, Katarzyna ; Zambon, Antonella ; Piperno, Alberto ; Modesti, Pietro Amedeo ; Agostoni, Piergiuseppe ; Mancia, Giuseppe. / 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. In: European Heart Journal. 2014 ; Vol. 35, No. 44. pp. 3113-3122.
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abstract = "Aim Many hypertensive subjects travel to high altitudes, but little is known on ambulatory blood pressure (ABP) changes and antihypertensive drugs' efficacy under acute and prolonged exposure to hypobaric hypoxia. In particular, the efficacy of angiotensin receptor blockers in this condition is unknown. This may be clinically relevant considering that renin-angiotensin system activity changes at altitude. The HIGHCARE-HIMALAYA study assessed changes in 24 h ABP under acute and prolonged exposure to increasing altitude and blood pressure-lowering efficacy and safety of an angiotensin receptor blockade in this setting. Methods and results Forty-seven healthy, normotensive lowlanders were randomized to telmisartan 80 mg or placebo in a double-blind, parallel group trial. Conventional and Ambulatory BPs were measured at baseline and on treatment: after 8 weeks at sea level, and under acute exposure to 3400 and 5400 m altitude, the latter upon arrival and after 12 days (Mt. Everest base camp). Blood samples were collected for plasma catecholamines, renin, angiotensin, and aldosterone. In both groups, exposure to increasing altitude was associated with: (i) significant progressive increases in conventional and 24 h blood pressure, persisting throughout the exposure to 5400 m; (ii) increased plasma noradrenaline and suppressed renin-angiotensin-aldosterone system. Telmisartan lowered 24 h ABP at the sea level and at 3400 m (between-group difference 4.0 mmHg, 95{\%} CI: 2.2-9.5 mmHg), but not at 5400 m. Conclusion Ambulatory blood pressure increases progressively with increasing altitude, remaining elevated after 3 weeks. An angiotensin receptor blockade maintains blood pressure-lowering efficacy at 3400 m but not at 5400 m.",
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T1 - Changes in 24 h ambulatory blood pressure and effects of angiotensin II receptor blockade during acute and prolonged high-altitude exposure

T2 - A randomized clinical trial

AU - Parati, Gianfranco

AU - Bilo, Grzegorz

AU - Faini, Andrea

AU - Bilo, Barbara

AU - Revera, Miriam

AU - Giuliano, Andrea

AU - Lombardi, Carolina

AU - Caldara, Gianluca

AU - Gregorini, Francesca

AU - Styczkiewicz, Katarzyna

AU - Zambon, Antonella

AU - Piperno, Alberto

AU - Modesti, Pietro Amedeo

AU - Agostoni, Piergiuseppe

AU - Mancia, Giuseppe

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Y1 - 2014/11/21

N2 - Aim Many hypertensive subjects travel to high altitudes, but little is known on ambulatory blood pressure (ABP) changes and antihypertensive drugs' efficacy under acute and prolonged exposure to hypobaric hypoxia. In particular, the efficacy of angiotensin receptor blockers in this condition is unknown. This may be clinically relevant considering that renin-angiotensin system activity changes at altitude. The HIGHCARE-HIMALAYA study assessed changes in 24 h ABP under acute and prolonged exposure to increasing altitude and blood pressure-lowering efficacy and safety of an angiotensin receptor blockade in this setting. Methods and results Forty-seven healthy, normotensive lowlanders were randomized to telmisartan 80 mg or placebo in a double-blind, parallel group trial. Conventional and Ambulatory BPs were measured at baseline and on treatment: after 8 weeks at sea level, and under acute exposure to 3400 and 5400 m altitude, the latter upon arrival and after 12 days (Mt. Everest base camp). Blood samples were collected for plasma catecholamines, renin, angiotensin, and aldosterone. In both groups, exposure to increasing altitude was associated with: (i) significant progressive increases in conventional and 24 h blood pressure, persisting throughout the exposure to 5400 m; (ii) increased plasma noradrenaline and suppressed renin-angiotensin-aldosterone system. Telmisartan lowered 24 h ABP at the sea level and at 3400 m (between-group difference 4.0 mmHg, 95% CI: 2.2-9.5 mmHg), but not at 5400 m. Conclusion Ambulatory blood pressure increases progressively with increasing altitude, remaining elevated after 3 weeks. An angiotensin receptor blockade maintains blood pressure-lowering efficacy at 3400 m but not at 5400 m.

AB - Aim Many hypertensive subjects travel to high altitudes, but little is known on ambulatory blood pressure (ABP) changes and antihypertensive drugs' efficacy under acute and prolonged exposure to hypobaric hypoxia. In particular, the efficacy of angiotensin receptor blockers in this condition is unknown. This may be clinically relevant considering that renin-angiotensin system activity changes at altitude. The HIGHCARE-HIMALAYA study assessed changes in 24 h ABP under acute and prolonged exposure to increasing altitude and blood pressure-lowering efficacy and safety of an angiotensin receptor blockade in this setting. Methods and results Forty-seven healthy, normotensive lowlanders were randomized to telmisartan 80 mg or placebo in a double-blind, parallel group trial. Conventional and Ambulatory BPs were measured at baseline and on treatment: after 8 weeks at sea level, and under acute exposure to 3400 and 5400 m altitude, the latter upon arrival and after 12 days (Mt. Everest base camp). Blood samples were collected for plasma catecholamines, renin, angiotensin, and aldosterone. In both groups, exposure to increasing altitude was associated with: (i) significant progressive increases in conventional and 24 h blood pressure, persisting throughout the exposure to 5400 m; (ii) increased plasma noradrenaline and suppressed renin-angiotensin-aldosterone system. Telmisartan lowered 24 h ABP at the sea level and at 3400 m (between-group difference 4.0 mmHg, 95% CI: 2.2-9.5 mmHg), but not at 5400 m. Conclusion Ambulatory blood pressure increases progressively with increasing altitude, remaining elevated after 3 weeks. An angiotensin receptor blockade maintains blood pressure-lowering efficacy at 3400 m but not at 5400 m.

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KW - Angiotensin receptor blockers

KW - Blood pressure

KW - High altitude

KW - Hypoxia

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