{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:24:49Z","timestamp":1776299089034,"version":"3.50.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,6,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Acute exposure to high\u2010altitude hypobaric hypoxia induces a blood pressure rise in hypertensive humans, both at rest and during exercise. It is unclear whether this phenomenon reflects specific blood pressure hyperreactivity or rather an upward shift of blood pressure levels. We aimed at evaluating the extent and rate of blood pressure rise during exercise in hypertensive subjects acutely exposed to high altitude, and how these alterations can be counterbalanced by antihypertensive treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Fifty\u2010five subjects with mild hypertension, double\u2010blindly randomized to placebo or to a fixed\u2010dose combination of an angiotensin\u2010receptor blocker (telmisartan 80\u00a0mg) and a calcium\u2010channel blocker (nifedipine slow release 30\u00a0mg), performed a cardiopulmonary exercise test at sea level and after the first night's stay at 3260\u00a0m altitude. High\u2010altitude exposure caused both an 8\u00a0mm\u00a0Hg upward shift (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) and a 0.4\u00a0mm\u00a0Hg\/mL\/kg per minute steepening (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05) of the systolic blood pressure\/oxygen consumption relationship during exercise, independent of treatment. Telmisartan\/nifedipine did not modify blood pressure reactivity to exercise (blood pressure\/oxygen consumption slope), but downward shifted (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) the relationship between systolic blood pressure and oxygen consumption by 26\u00a0mm\u00a0Hg, both at sea level and at altitude. Muscle oxygen delivery was not influenced by altitude exposure but was higher on telmisartan\/nifedipine than on placebo (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In hypertensive subjects exposed to high altitude, we observed a hypoxia\u2010driven upward shift and steepening of the blood pressure response to exercise. The effect of the combination of telmisartan\/nifedipine slow release outweighed these changes and was associated with better muscle oxygen delivery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Clinical Trial Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              <jats:styled-content style=\"fixed-case\">URL<\/jats:styled-content>\n              :\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier:\n              <jats:styled-content style=\"fixed-case\">NCT<\/jats:styled-content>\n              01830530.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.008506","type":"journal-article","created":{"date-parts":[[2018,6,9]],"date-time":"2018-06-09T09:15:11Z","timestamp":1528535711000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Upward Shift and Steepening of the Blood Pressure Response to Exercise in Hypertensive Subjects at High Altitude"],"prefix":"10.1161","volume":"7","author":[{"given":"Sergio","family":"Caravita","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Faini","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Baratto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano Milan Italy"},{"name":"Department of Medicine and Surgery University of Milano\u2010Bicocca Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grzegorz","family":"Bilo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano Milan Italy"},{"name":"Department of Medicine and Surgery University of Milano\u2010Bicocca Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e8 Luis","family":"Macarlupu","sequence":"additional","affiliation":[{"name":"Laboratorio de Fisiologia Comparada Facultad de Ciencias y Filosofia Universidad Peruana Cayetano Heredia Lima Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morin","family":"Lang","sequence":"additional","affiliation":[{"name":"Department de Ciencias de la Rehabilitaci\u00f3n y del Movimiento Humano Universidad de Antofagasta Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Revera","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano Milan Italy"},{"name":"Department of Medicine and Surgery University of Milano\u2010Bicocca Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco C.","family":"Villafuerte","sequence":"additional","affiliation":[{"name":"Laboratorio de Fisiologia Comparada Facultad de Ciencias y Filosofia Universidad Peruana Cayetano Heredia Lima Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piergiuseppe","family":"Agostoni","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS Milan Italy"},{"name":"Department of Clinical Sciences and Community Health University of Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianfranco","family":"Parati","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Neural and Metabolic Sciences, S. 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