Blood pressure response to exposure to moderate altitude in patients with COPD

• Published in: International journal of chronic obstructive pulmonary disease 2019-03, Vol.14, p.659-666
• Main Authors: Schwarz, Esther I, Latshang, Tsogyal D, Furian, Michael, Flück, Deborah, Segitz, Sebastian, Müller-Mottet, Severine, Ulrich, Silvia, Bloch, Konrad E, Kohler, Malcolm
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Altitude; Atmospheric pressure; Autonomic Nervous System - physiopathology; Baroreflex; baroreflex sensitivity; Blood Pressure; blood pressure variability; Cardiovascular disease; Cardiovascular diseases; Cardiovascular system; Cardiovascular System - innervation; Care and treatment; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Circadian Rhythm; Ethics; Exercise; Female; Forced Expiratory Volume; Heart rate; Humans; hypobaric hypoxia; Hypoxia; Laws, regulations and rules; Lung - physiopathology; Male; Medical law; Middle Aged; Original Research; Patients; Physical fitness; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - physiopathology; Severity of Illness Index; Sleep; Software; Time Factors; Young Adult
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S194426

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. 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. Thirty-seven patients with moderate to severe COPD (mean±SD age 64±6 years, FEV 60%±17%) were included. Morning SBP increased by +10.8 mmHg (95% CI: 4.7-17.0, =0.001) and morning DBP by +5.0 mmHg (95% CI: 0.8-9.3, =0.02) in response to altitude exposure. BRS significantly decreased ( =0.03), whereas BPV significantly and progressively increased (