Risk factors and outcomes of HPH in high-altitude residents via echocardiographic evaluation

Over 80 million people live above 2,500 m, where hypobaric hypoxia increases hypoxic pulmonary hypertension (HPH) risk. In Qinghai, China (> 3,000 m), over 5 million face a high HPH burden with limited medical resources.

To evaluate risk factors and outcomes of HPH in high-altitude residents using echocardiography.

This retrospective study analyzed 627 HPH patients (PASP > 50 mmHg) in Qinghai (2018-2022), categorized as moderate (50 < PASP < 70 mmHg) or severe (PASP ≥ 70 mmHg). Clinical, biochemical, and echocardiographic data were assessed, with mortality tracked via telephone follow-up after ≥ 1 year. Logistic and Cox regression identified severity and mortality predictors.

Among 627 high-altitude residents with HPH, 360 (57.4%) had moderate HPH (50 < PASP < 70 mmHg) and 267 (42.6%) had severe HPH (PASP ≥ 70 mmHg). Severe HPH was associated with higher APTT (p = 0.004), LPa (p = 0.004), cyanosis (p = 0.003), and right ventricular hypertrophy (p = 0.001) via multivariate logistic regression. Mortality predictors, identified by multivariate Cox regression, included LPa (p = 0.001), atrial fibrillation (p = 0.003), heart failure (p = 0.021), and alcohol consumption (p = 0.013).

In Qinghai's high-altitude residents, APTT, LPa, cyanosis, and right ventricular hypertrophy drive severe HPH, while LPa, atrial fibrillation, heart failure, and alcohol consumption predict mortality. Monitoring APTT and LPa may aid early detection, and managing modifiable factors like alcohol and atrial fibrillation could reduce mortality in resource-limited settings.