title: Ambulatory blood pressure in untreated and treated hypertensive patients at high altitude: the High Altitude Cardiovascular Research-Andes study.
abstract: Blood pressure increases during acute exposure to high altitude in healthy humans. However, little is known on altitude effects in hypertensive subjects or on the treatment efficacy in this condition. Objectives of High Altitude Cardiovascular Research (HIGHCARE)-Andes Lowlanders Study were to investigate the effects of acute high-altitude exposure on 24-hour ambulatory blood pressure in hypertensive subjects and to assess antihypertensive treatment efficacy in this setting. One hundred untreated subjects with mild hypertension (screening blood pressure, 144.1±9.8 mm Hg systolic, 92.0±7.5 mm Hg diastolic) were randomized to double-blind placebo or to telmisartan 80 mg+modified release nifedipine 30 mg combination. Twenty-four-hour ambulatory blood pressure monitoring was performed off-treatment, after 6 weeks of treatment at sea level, on treatment during acute exposure to high altitude (3260 m) and immediately after return to sea level. Eighty-nine patients completed the study (age, 56.4±17.6 years; 52 men/37 women; body mass index, 28.2±3.5 kg/m(2)). Twenty-four-hour systolic blood pressure increased at high altitude in both groups (placebo, 11.0±9 mm Hg; P<0.001 and active treatment, 8.1±10.4 mm Hg; P<0.001). Active treatment reduced 24-hour systolic blood pressure both at sea level and at high altitude (147.9±11.1 versus 132.6±12.4 mm Hg for placebo versus treated; P<0.001; 95% confidence interval of the difference 10.9-19.9 mm Hg) and was well tolerated. Similar results were obtained for diastolic, for daytime blood pressure, and for nighttime blood pressure. Treatment was well tolerated in all conditions. Our study demonstrates that (1) 24-hour blood pressure increases significantly during acute high-altitude exposure in hypertensive subjects and (2) treatment with angiotensin receptor blocker-calcium channel blocker combination is effective and safe in this condition.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01830530.
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Bilo
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Villafuerte
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Andrea
authors.initials: A
authors.lastname: Faini
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Cecilia
authors.initials: C
authors.lastname: Anza-Ramírez
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Miriam
authors.initials: M
authors.lastname: Revera
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Andrea
authors.initials: A
authors.lastname: Giuliano
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Sergio
authors.initials: S
authors.lastname: Caravita
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Francesca
authors.initials: F
authors.lastname: Gregorini
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Carolina
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Salvioni
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Macarlupu
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Deborah
authors.initials: D
authors.lastname: Ossoli
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Leah
authors.initials: L
authors.lastname: Landaveri
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Morin
authors.initials: M
authors.lastname: Lang
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Sosa
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.affiliation: From the Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B., A.F., M.R., A.G., S.C., F.G., C.L., D.O., G.M., G.P.); Laboratorio de Fisiologia Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia, Lima, Peru (F.C.V., C.A.-R., J.L.M., L.L., J.M.S.); Department of Health Sciences, Università di Milano-Bicocca, Milan, Italy (S.C., G.M., G.P.); Heart Failure Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (E.S., P.A.); Departamento De Ciencias De La Rehabilitación Y Movimiento Humano, Universidad de Antofagasta, Antofagasta, Chile (M.L.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Milan, Italy (P.A.). gianfranco.parati@unimib.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
mesh_terms: D000328:Adult; D000368:Aged; D000531:Altitude; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination / Q000379:methods; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D016001:Confidence Intervals; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: altitude; anoxia; antihypertensive agents; blood pressure; blood pressure monitoring, ambulatory