Hypertension at Altitude

Will my blood pressure be impacted when I travel to high altitude?
It is not uncommon for lowland visitors with a history of high blood pressure to
experience higher blood pressure at altitude. This can occur even if blood pressure is well
controlled with medication at sea level. However, only a small percentage of these people will
experience unusually unstable blood pressure at altitude. Increased blood pressure at altitude
usually returns to baseline after 1-2 weeks at altitude.
So why does this happen?
One explanation is due to the higher levels of adrenaline in your body due to lower oxygen
levels causing increased heart rate in attempt to increase oxygen circulation throughout the body.
This mechanism supports the findings that increased blood pressure will normalize after 1-2
weeks at increased elevation.
How can I safely plan a trip to high altitude if I have hypertension?
In general, it is unnecessary to change your blood pressure medication dosage before or upon
arrival to elevation. Increasing dosage could result in dangerously low blood pressure upon
returning to low altitude. However, if you are experiencing symptoms from your high blood
pressure such as headache, dizziness, chest pain, or shortness of breath, you should seek medical
treatment. It is also recommended to bring your own blood pressure monitor on your trip. If your
blood pressure rises above 180/90 you are at risk of entering a state of hypertensive urgency and
if it rises above 200/100 this can cause a hypertensive emergency where end organ damage is
possible. In either condition you should seek medical advice whether from your Primary Care
Physician or the Emergency Department if blood pressure is dangerously high. Unfortunately,
there is little information available about the treatment of significantly elevated blood pressure
that is secondary to a quick ascent to elevation and will likely be managed similar to a
hypertensive crisis at sea level with the use of an anti-hypertensive medication chosen by your
healthcare professional. The use of supplemental oxygen, especially at night can also reduce
symptoms and lower blood pressure in some visitors and residents in the mountains.

Written by Grace Murk, PA-S

References
1. Andrew M. Luks. High Altitude Medicine & Biology. March 2009, 10(1): 11-
15.https://doi.org/10.1089/ham.2008.1076
2. Institute For Altitude Medicine (2017). Altitude and Pre-Existing Conditions. [online]
Institute For Altitude Medicine. Available at: http://www.altitudemedicine.org/altitude-and-
pre-existing- conditions/ [Accessed 15 Oct. 2017].
3. Handler J. Altitude-related hypertension. J Clin Hypertens (Greenwich). 2009;11:161–165.
4. Gilbert-Kawai E, Martin D, Grocott M, Levett D. High altitude-related hypertensive crisis
and acute kidney injury in an asymptomatic healthy individual. Extreme Physiology &
Medicine. 2016;5:10. doi:10.1186/s13728-016- 0051-3.

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