Blood pressure response to exposure to moderate altitude in patients with COPD
Received 13 November 2018
Accepted for publication 31 January 2019
Published 14 March 2019 Volume 2019:14 Pages 659—666
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Esther I Schwarz,1 Tsogyal D Latshang,1 Michael Furian,1 Deborah Flück,1 Sebastian Segitz,1 Severine Müller-Mottet,1 Silvia Ulrich,1 Konrad E Bloch,1,2 Malcolm Kohler1,2
1Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland; 2Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
Purpose: Patients with COPD might be particularly susceptible to hypoxia-induced autonomic dysregulation. Decreased baroreflex sensitivity (BRS) and increased blood pressure (BP) variability (BPV) are markers of impaired cardiovascular autonomic regulation and there is evidence for an association between decreased BRS/increased BPV and high cardiovascular risk. The aim of this study was to evaluate the effect of short-term exposure to moderate altitude on BP and measures of cardiovascular autonomic regulation in COPD patients.
Materials and methods: Continuous morning beat-to-beat BP was noninvasively measured with a Finometer® device for 10 minutes at low altitude (490 m, Zurich, Switzerland) and for 2 days at moderate altitude (2,590 m, Davos Jakobshorn, Switzerland) – the order of altitude exposure was randomized. Outcomes of interest were mean SBP and DBP, BPV expressed as the coefficient of variation (CV), and spontaneous BRS. Changes between low altitude and day 1 and day 2 at moderate altitude were assessed by ANOVA for repeated measurements with Fisher’s exact test analysis.
Results: Thirty-seven patients with moderate to severe COPD (mean±SD age 64±6 years, FEV1 60%±17%) were included. Morning SBP increased by +10.8 mmHg (95% CI: 4.7–17.0, P=0.001) and morning DBP by +5.0 mmHg (95% CI: 0.8–9.3, P=0.02) in response to altitude exposure. BRS significantly decreased (P=0.03), whereas BPV significantly and progressively increased (P<0.001) upon exposure to altitude.
Conclusion: Exposure of COPD patients to moderate altitude is associated with a clinically relevant increase in BP, which seems to be related to autonomic dysregulation.
Clinical trial registration: ClinicalTrials.gov (NCT01875133).
Keywords: COPD, hypobaric hypoxia, baroreflex sensitivity, blood pressure variability
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