The Heart and Pulmonary Circulation at High Altitudes: Healthy Highlanders and Chronic Mountain Sickness
Open accessAbstract
More than 140 million people worldwide live >2500 m above sea level. Of them, 80 million live in Asia, and 35 million live in the Andean mountains. This latter region has its major population density living above 3500 m. The primary objective of the present study is to review the physiology, pathology, pathogenesis, and clinical features of the heart and pulmonary circulation in healthy highlanders and patients with chronic mountain sickness. A systematic review of worldwide literature was undertaken, beginning with the pioneering work done in the Andes several decades ago. Original articles were analyzed in most cases and English abstracts or translations of articles written in Chinese were reviewed. Pulmonary hypertension in healthy highlanders is related to a delayed postnatal remodeling of the distal pulmonary arterial branches. The magnitude of pulmonary hypertension increases with the altitude level and the degree of exercise. There is reversal of pulmonary hypertension after prolonged residence at sea level. Chronic mountain sickness develops when the capacity for altitude adaptation is lost. These patients have moderate to severe pulmonary hypertension with accentuated hypoxemia and exaggerated polycythemia. The clinical picture of chronic mountain sickness differs from subacute mountain sickness and resembles other chronic altitude diseases described in China and Kyrgyzstan. The heart and pulmonary circulation in healthy highlanders have distinct features in comparison with residents at sea level. Chronic mountain sickness is a public health problem in the Andean mountains and other mountainous regions around the world. Therefore, dissemination of preventive and therapeutic measures is essential.
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Tibetan residents of Han Chinese descent are much more frequently affected by CMS than native Tibetans, and this represents a major public health burden.
“In contrast, Tibetan residents of Han Chinese descent are much more frequently affected by CMS, which represents a major public health burden.”
From Regulation of erythropoiesis by hypoxia-inducible factors (2013) · cites this paper as [165]
Chronic mountain sickness is less common in native Tibetans than in Andean high-altitude populations living at comparable altitude.
“While the disease is prevalent in the Andean population, it is less common in native Tibetans, who live at comparable altitude.”
From Regulation of erythropoiesis by hypoxia-inducible factors (2013) · cites this paper as [165]
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Pathophysiology and epidemiology of chronic mountain sickness
Monge-C, C., Arregui, A., & León-Velarde, F. (1992) · International Journal of Sports Medicine · doi:10.1055/s-2007-1024603 · Cited by 153 · see citing works
Chronic Mountain Sickness in Tibet
PEI, S. X., CHEN, X. J., SI REN, B. Z., LIU, Y. H., CHENG, X. S., HARRIS, E. M., ANAND, I. S., & C.HARRIS, P. (1989) · QJM: An International Journal of Medicine · doi:10.1093/oxfordjournals.qjmed.a068349 · Cited by 90 · see citing works
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Regulation of erythropoiesis by hypoxia-inducible factors
Haase, V. H. (2013) · Blood Reviews · doi:10.1016/j.blre.2012.12.003 · Cited by 787 · see citing works
Anaemia in kidney disease: harnessing hypoxia responses for therapy
Koury, M. J., & Haase, V. H. (2015) · Nature Reviews Nephrology · doi:10.1038/nrneph.2015.82 · Cited by 313 · see citing works
Artificial intelligence for early prediction of pulmonary hypertension using electrocardiography
Kwon, J.-M., Kim, K.-H., Medina-Inojosa, J., Jeon, K.-H., Park, J., & Oh, B.-H. (2020) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2020.04.009 · Cited by 108 · see citing works
Gonzales, G. F., Gasco, M., Tapia, V., & Gonzales-Castañeda, C. (2009) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.90940.2008 · Cited by 51 · see citing works
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- Authors
- Penaloza, D., & Arias-Stella, J.
- Affiliations
- From the Department of Medicine (D.P.) and Department of Pathology (J.A.-S.), Faculty of Medicine; and the High Altitude Research Institute (D.P., J.A.-S.), Faculty of Sciences, University Cayetano Heredia, Lima, Peru.
- Venue
- Circulation
- Published
- 2007-03-06
- Volume
- 115
- Issue
- 9
- Pages
- 1132-1146
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2051152628
- Cited by
- 643
- References
- 2
- Citations by year
- 2026: 39 · 2025: 38 · 2024: 45 · 2023: 44 · 2022: 42 · 2021: 41 · 2020: 43 · 2019: 21 · 2018: 27 · 2017: 29 · 2016: 25 · 2015: 39 · 2014: 40 · 2013: 36 · 2012: 36
- FWCI
- 11.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › High Altitude and Hypoxia
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- high altitude, chronic mountain sickness, pulmonary hypertension, pulmonary circulation, heart, Highlanders, high-altitude adaptation, hypoxemia, polycythemia, Andes, pulmonary artery remodeling, altitude physiology
- MeSH terms
- Adaptation, Physiological, Adolescent, Adult, Aged, Aged, 80 and over, Altitude, Altitude Sickness, Animals, Hypoxia, Cardiac Output, Cattle, Cattle Diseases, Child, Child, Preschool, China, Chronic Disease, Diagnosis, Differential, Female, Cardiac Catheterization, Heart Ventricles, Humans, Hypertension, Pulmonary, Infant, Infant, Newborn, Latin America, Male, Middle Aged, Muscle, Smooth, Vascular, Polycythemia, Pulmonary Artery, Pulmonary Circulation, Pulmonary Heart Disease, Vasodilator Agents, Exercise, Ventricular Function, Hypertrophy, Right Ventricular
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