Pathophysiology and epidemiology of chronic mountain sickness
Open accessAbstract
Chronic mountain sickness, which affects permanent residents of high altitudes, is the outcome of a progressive loss of ventilatory rate which naturally occurs with age and resulting in excessive hypoxemia and polycythemia. A theoretical model predicts the progressive failure of homeostatic control of the hemoglobin concentration when the values increase above those found at sea level. This is confirmed by lack of feedback mechanism between high altitude erythrocytosis and serum erythropoietin. The results of epidemiological studies are in agreement with the physiological findings. In a male population living at 4,300 m, an increase with age of the prevalences of excessive erythrocytosis (Hb > 213 g/l), blood oxygen saturation < 83%, headaches and a high score of symptoms of chronic mountain sickness has been found. The studies suggest the possibility that in addition to an accentuated hypoxemia, the excessive erythrocytosis may also result from an overreaction of the bone marrow to a fixed level of hypoxemia in ageing individuals.
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“moldavica against CMS, although the herb has shown efficient cardiac activities.[8,9] Thus, the present study was aimed to explore the effect of D.”
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“[2,4,6,7] Fewer studies have been conducted in the Himalayas and Tibetan Plateau.”
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“6% in Peruvians living in Cerro de Pasco (4340 m), mainly of male gender.(13) Preliminary evidence links CMS with higher BP level.”
BackgroundProposal for Scoring Severity in Chronic Mountain Sickness (Cms)
Lèon‐Velarde, F., McCullough, R. G., McCullough, R. E., & Reeves, J. Τ. (2003) · Advances in experimental medicine and biology · doi:10.1007/978-1-4419-8997-0_24 · Cited by 34 · see citing works
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“CMS is diagnosed on the basis of the presence of EE accompanied by three or more of the following symptoms: breathlessness, palpitations, sleep disturbance, cyanosis, dilation of veins, paresthesia, headache, or tinnitus (29, 33, 39) according to the Qinghai International Consensus scoring system (30).”
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“Chronic mountain sickness (CMS, also known asMonge’s disease) is a serious condition that occurs in life-long high altitude residents who are mal-adapted to their hypobaric environment (Monge, 1942; Monge et al., 1992; Xing et al., 2008).”
BackgroundPlasma catecholamines and blood volume in native Andeans during hypoxia and normoxia
Gamboa, A. C., Gamboa, J. L., Holmes, C. S., Sharabi, Y., Lèon‐Velarde, F., Fischman, G. J., Appenzeller, O., & Goldstein, D. S. (2006) · Clinical Autonomic Research · doi:10.1007/s10286-006-0305-z · Cited by 31 · see citing works
Self-citationEffect of acetazolamide on ventilatory response in subjects with chronic mountain sickness
Rivera, M. C., Huicho, L., Bouchet, P., et al. (2008) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2008.06.010 · Cited by 27 · see citing works
Self-citationSerum testosterone levels and score of chronic mountain sickness in Peruvian men natives at 4340 m
Gonzales, G. F., Tapia, V., Gasco, M., & Gonzales‐Castañeda, C. (2011) · Andrologia · doi:10.1111/j.1439-0272.2010.01046.x · Cited by 28 · see citing works
“This is in accordance with epidemiological studies showing that CMS increases with age (Monge et al., 1992) mainly in men who have had hypoxia-responsive genes when they were children (Huicho et al.”
BackgroundResultPrenatal hypoxia: relevance to developmental origins of health and disease
Giussani, D. A. (2006) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544699.013 · Cited by 26 · see citing works
Negi, P. C., Asotra, S., Kumar, R., Marwah, R., Kandoria, A. K., Ganju, N., Sharma, R. K., & Bhardwaj, R. (2013) · High Altitude Medicine & Biology · doi:10.1089/ham.2012.1127 · Cited by 27 · see citing works
“The mean level of Hb was 15.5 – 3.2 and is similar to Tibetan population but lower than the values reported in Andean population (Beall, 2000; Monge et al., 1992, Wu et al 1998a, 1998b, 1998c).”
InfluentialAdaptive cardiorespiratory changes to chronic continuous and intermittent hypoxia
Prabhakar, N. R., Peng, Y., & Nanduri, J. (2022) · Handbook of clinical neurology · doi:10.1016/b978-0-323-91534-2.00009-6 · Cited by 26 · see citing works
Severe gastritis in the Peruvian Andes
Recavarren‐Arce, S., Ramírez‐Ramos, A., Gilman, R. H., et al. (2005) · Histopathology · doi:10.1111/j.1365-2559.2005.02102.x · Cited by 26 · see citing works
“Physiologically, the chronic hypoxaemia observed at high altitude leads to polycythemia, which in turn increases blood viscosity, resulting in decreased vascular perfusion and increased stasis, as well as ischaemia.(1,21,22) Additionally, Andean natives exhibit autonomic alterations that may induce vascular and muscul…”
BackgroundKüpper, T., Milledge, J. S., Hillebrandt, D., et al. (2011) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/meq102 · Cited by 26 · see citing works
Acetazolamide and N-acetylcysteine in the treatment of chronic mountain sickness (Monge’s disease)
Sharma, S., Gralla, J., Ordonez, J. G., et al. (2017) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2017.07.005 · Cited by 25 · see citing works
Gonzales, G. F., & Villena, A. (2000) · International Journal of Gynecology & Obstetrics · doi:10.1016/s0020-7292(00)00270-8 · Cited by 24 · see citing works
Hackett, P. H., & Roach, R. C. (2007) · Elsevier eBooks · doi:10.1016/b978-0-323-03228-5.50006-9 · Cited by 25 · see citing works
Pei, T., Li, X., Tao, F., Xu, H., You, H., Zhou, L., Liu, Y., & Gao, Y. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-401 · Cited by 24 · see citing works
“6% [37], which is similar to our findings (4,000-4,499 m: 13.”
Bermúdez, D., Azad, P., Figueroa‐Mujíca, R., Vizcardo‐Galindo, G. A., Corante, N., Guerra‐Giraldez, C., Haddad, G. G., & Villafuerte, F. C. (2019) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00250.2019 · Cited by 24 · see citing works
“The prevalence of CMS increases with altitude, and the condition develops insidiously from early adulthood, progressing with age (27, 34, 36).”
BackgroundAltitude hypoxia and hypoxemia: pathogenesis and management
Cai, C., Ni, G., Chen, L., Deng, C., Chai, S., Wang, R., Zhang, R., Luo, F., & Ge, R.-L. (2026) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-025-02531-1 · Cited by 29 · see citing works
“64 Notably, signi fi cant variation across different high-altitude populations is primarily attributed to ethnic differences, considering similar altitudes and uniform diagnostic criteria.”
Relationships Between Chemoreflex Responses, Sleep Quality, and Hematocrit in Andean Men and Women
Heinrich, E. C., Orr, J. E., Gilbertson, D., Anza‐Ramirez, C., DeYoung, P. N., Djokic, M. A., Corante, N., Vizcardo‐Galindo, G. A., Macarlupú, J. L., Gaio, E., et al. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.00437 · Cited by 24 · see citing works
Zhang, P., Li, Z., Yang, F., Ji, L., Yang, Y., Liu, C., Liu, H., Ma, J., Liu, J., Dang, Z., et al. (2021) · Bioscience Reports · doi:10.1042/bsr20202219 · Cited by 23 · see citing works
Bhattacharya, S., Shrimali, N. M., Mohammad, G., Koul, P. A., Prchal, J. T., & Guchhait, P. (2021) · EBioMedicine · doi:10.1016/j.ebiom.2021.103418 · Cited by 23 · see citing works
Gonzales, G. F., & Chaupis-Meza, D. (2014) · Andrologia · doi:10.1111/and.12359 · Cited by 23 · see citing works
“In addition, prevalence of excessive erythrocytosis increases with age in men (Monge et al., 1989, 1992) and in women (Gonzales & Villena, 2000; Gonzales, 2011) and both were associated with an increase in CMS prevalence.”
BackgroundSamaja, M., & Ottolenghi, S. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24043670 · Cited by 28 · see citing works
López‐Barneo, J., de Tassigny, X. D., Sirerol-Piquer, M. S., Gómez‐Pinedo, U., Pardal, R., Bonilla, S., Capilla‐González, V., de la Torre, J., García‐Verdugo, J. M., & López‐López, I. (2015) · Hypoxia · doi:10.2147/hp.s78248 · Cited by 22 · see citing works
Jiang, C., Cui, J., Liu, F., Gao, L., Luo, Y., Li, P., Guan, L., & Gao, Y. (2014) · PLoS ONE · doi:10.1371/journal.pone.0087775 · Cited by 21 · see citing works
“In addition, obvious differences in the incidences of HAPC have been reported between different races, such as between Tibetans, Han Chinese, and Andean natives [3,4,23].”
BackgroundBlood lead levels in Peruvian adults are associated with proximity to mining and DNA methylation
Childebayeva, A., Goodrich, J. M., Chesterman, N. S., Lèon‐Velarde, F., Rivera, M. C., Kiyamu, M., Brutsaert, T. D., Bigham, A. W., & Dolinoy, D. C. (2021) · Environment International · doi:10.1016/j.envint.2021.106587 · Cited by 20 · see citing works
“Andeans are known to have elevated Hb levels at high altitude, which counteract the environmental hypoxia and maintain optimal oxygen saturation (Monge et al. 1992; Moore 2001).”
Self-citationApoptosis is one cause of thrombocytopenia in patients with high-altitude polycythemia
Wang, Z., Tenzing, N., Xu, Q., Liu, H., Ye, Y., Wen, Y., Wuren, T., & Cui, S. (2023) · Platelets · doi:10.1080/09537104.2022.2157381 · Cited by 20 · see citing works
“Males are reportedly more prone to HAPC than females [14,15].”
BackgroundSurvival and Mortality in Older Adults Living at High Altitude in Bolivia: A Preliminary Report
Ortega, J. V., Hogan, A. M., Botti, A. B., Kirkham, F. J., Baldeweg, T., Mahíllo, I., de Pedro‐Cuesta, J., Bucks, R. S., & On behalf of the Bolivian Children Living at Altitude Project (BoCLA 2006) (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02468.x · Cited by 19 · see citing works
Villafuerte, F. C., Corante, N., Anza‐Ramirez, C., Figueroa‐Mujíca, R., Vizcardo‐Galindo, G. A., Mercado, A., Macarlupú, J. L., & Lèon‐Velarde, F. (2016) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00107.2016 · Cited by 19 · see citing works
“6 g/dl in women), and it is frequently accompanied by exaggerated hypoxemia (17, 20, 25, 26).”
BackgroundMethodSelf-citationAdaptation à l’hypoxie chronique des populations de haute altitude
Richalet, J. (2021) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2020.11.007 · Cited by 17 · see citing works
West, C. M., Wearing, O. H., Rhem, R. G., et al. (2021) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00282.2020 · Cited by 17 · see citing works
Hocine, Z., & Zhang, J. (2014) · International Journal of Information Systems and Change Management · doi:10.1504/ijiscm.2014.069397 · Cited by 20 · see citing works
Cardiometabolic correlates of sleep disordered breathing in Andean highlanders
Pham, L. V., Miele, C. H., Schwartz, N. G., Arias, R. S., Rattner, A., Gilman, R. H., Miranda, J. J., Polotsky, V. Y., Checkley, W., & Schwartz, A. R. (2017) · European Respiratory Journal · doi:10.1183/13993003.01705-2016 · Cited by 17 · see citing works
Cardio-Pulmonary Interactions at High Altitude
Maggiorini, M. (2003) · Advances in experimental medicine and biology · doi:10.1007/978-1-4419-8997-0_13 · Cited by 17 · see citing works
- Authors
- Monge-C, C., Arregui, A., & León-Velarde, F.
- Affiliations
- Universidad Peruana Cayetano Heredia (PE)
- Venue
- International Journal of Sports Medicine
- Publisher
- Georg Thieme Verlag KG
- Published
- 1992-10
- Volume
- 13
- Issue
- S 1
- Pages
- S79-S81
- ISSN
- 0172-4622 (ISSN-L)
- 1439-3964
- OpenAlex
- W1995517473
- Cited by
- 153
- References
- 14
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 12 · 2020: 5 · 2019: 4 · 2018: 3 · 2017: 8 · 2016: 9 · 2015: 9 · 2014: 9 · 2013: 10 · 2012: 4
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- cc-by-nc-nd
- Locations
- International Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Universidad Peruana Cayetano Heredia Institutional Repository (submittedVersion, cc-by-nc-nd)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › High Altitude and Hypoxia
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Keywords
- chronic mountain sickness, high altitude, hypoxemia, polycythemia, erythrocytosis, erythropoietin, hemoglobin levels, respiratory rate, aging, prevalence, headache
- MeSH terms
- Adult, Aged, Aging, Altitude Sickness, Hypoxia, Chronic Disease, Erythropoietin, Homeostasis, Humans, Hypoventilation, Male, Middle Aged, Models, Theoretical, Peru, Polycythemia, Prevalence
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