Initial orthostatic hypotension at high altitude

Thomas, Kate N., Keith R. Burgess, Rishi Basnyat, Samuel J.E. Lucas, James D. Cotter, Jui-Lin Fan, Karen C. Peebles, Rebekah A.I. Lucas, Philip N. Ainslie. Initial orthostatic hypotension at high altitude. High Alt. Med. Biol. 11:163-167, 2010.-There are several reports on syncope occurring following standing at high altitude (HA), yet description of the detailed physiological responses to standing at HA are lacking. We examined the hypothesis that appropriate physiological adjustments to upright posture would be compromised at HA (5050m). Ten healthy volunteers stood up rapidly from supine rest, for 3min, at sea level and at 5050m. Beat-to-beat mean arterial blood pressure (MAP, Finometer), middle cerebral artery blood velocity (MCAv, Transcranial Doppler), end-tidal PCO₂ and PO₂, and heart rate (ECG) were recorded continuously. After 14 days at HA, baseline MAP and MCAv were not different to sea level, although HR was elevated. Neither the magnitude of initial (<15s) responses to standing, nor the time course of initial recovery differed at HA compared with sea level (p>0.05). By 3min of standing, MAP was restored to supine values both at sea level (-3±12mmHg) and HA (4±10mmHg), although there was more complete recovery of HR at sea level (+13±10b•min^-1, p=0.02 vs.+23±10b•min ^-1, p=0.01). Reduced MCAv at 3min was comparable at sea level and altitude (both-16%). These data indicate that initial cardiovascular and cerebrovascular responses to standing are unaltered when partially acclimatized to HA.