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This trend coincides with a population that is increasingly medically complex, emphasizing the importance of understanding how preexisting medical conditions are influenced by ascent to high altitude. This narrative review summarizes the current evidence describing the physiologic and clinical implications of altitude exposure among individuals with chronic medical conditions. A comprehensive literature search was conducted across multiple databases and sources using inclusive keyword and phrase strategies related to high altitude and preexisting medical conditions. All relevant peer-reviewed studies, reviews, and consensus statements were reviewed to ensure a thorough synthesis of available data. The discussion is organized by body system, encompassing cardiovascular, pulmonary, neurologic, metabolic, hematologic, and other relevant conditions. Findings indicate that while many patients with stable, well-managed chronic illnesses can tolerate moderate or even high altitudes, those with advanced cardiopulmonary disease or cerebrovascular pathology face heightened risk and warrant individualized evaluation prior to ascent. This review provides practical, evidence-based guidance to clinicians, expedition planners, and emergency providers caring for high altitude travelers with preexisting conditions. 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