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(Circulation. 1997;96:1224-1232.)
© 1997 American Heart Association, Inc.

Articles

Effect of High-Altitude Exposure in the Elderly

The Tenth Mountain Division Study

Benjamin D. Levine, MD; Julie H. Zuckerman, RN, RDMS; ; Christopher R. deFilippi, MD

From The Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas (B.D.L., J.H.Z.), and the Department of Internal Medicine/Division of Cardiology, University of Texas Southwestern Medical Center at Dallas (B.D.L., C.R.deF.).

Background More than 5 million people/year over age 60 visit high altitude, which may exacerbate underlying cardiac or pulmonary disease. We hypothesized that the elderly would exhibit an impaired functional capacity at altitude, with increased myocardial ischemia compared with sea level (SL).

Methods and Results Twenty veterans (68±3 years) were studied at (1) SL, (2) acute simulated altitude to 2500 m, and (3) after 5 days of acclimatization to 2500 m. With acute altitude, PaO₂ and oxyhemoglobin saturation decreased and pulmonary artery pressure increased 43%, associated with sympathetic activation. O_2peak decreased 12% acutely but normalized after acclimatization. The best predictor of O_2peak with acute altitude was O_2peak at SL (r=.94). The double product that induced 1-mm ST depression during exercise with acute altitude was 5% less than SL but normalized after acclimatization. One patient with severe coronary disease sustained a myocardial infarction after an exercise test.

Conclusions Moderate altitude exposure in the elderly is associated with hypoxemia, sympathetic activation, and pulmonary hypertension resulting in a reduced exercise capacity that is predictable based on exercise performance at SL. Patients with coronary artery disease who are well compensated at SL do well at moderate altitude, although acutely ischemia may be provoked at modestly lower myocardial and systemic work rates. The elderly acclimatize well with normalization of SL performance after 5 days. A prudent policy would be for elderly individuals, particularly those with coronary artery disease, to limit their activity during the first few days at altitude to allow this acclimatization process to occur.

Key Words: aging • coronary disease • exercise • hypoxia • physiology

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