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Altitude-Associated Hemodynamic Alterations: Analysis from the Veterans Affairs Clinical Assessment, Reporting, and
Brian A Houston1, Suman Kundu2, Jonah Garry2
1Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC.
Annals of the American Thoracic Society
|July 14, 2026
Summary
Rising altitude below 2000m significantly alters pulmonary artery pressures and resistance. These hemodynamic changes can affect pulmonary hypertension diagnosis and treatment eligibility.
Area of Science:
- Cardiovascular Physiology
- Altitude Medicine
- Pulmonary Hypertension Research
Background:
- Pulmonary artery (PA) pressures and pulmonary vascular resistance (PVR) elevations are known above 2400m.
- Hemodynamic effects of lower altitude changes (<2000m) remain largely unstudied.
Purpose of the Study:
- To investigate hemodynamic alterations associated with altitude increases below 2000m.
- To assess the impact of modest altitude changes on pulmonary artery hemodynamics.
Main Methods:
- Analysis of a large cohort (91,128 patients) using the VA CART database.
- Linear regression modeling to assess the association between hemodynamic parameters and altitude, adjusting for covariates.
Main Results:
- Mean PA pressure and PVR increased with rising altitude (0-1640m).
- The likelihood of meeting criteria for pulmonary hypertension (PH) increased with altitude.
- Patients with reduced ejection fraction (<40%) showed a higher likelihood of elevated PVR at higher altitudes (≥1000m).
Conclusions:
- Even modest altitude increases (0-1640m) cause significant pulmonary artery hemodynamic changes.
- These altitude-related hemodynamic shifts may influence PH diagnosis, classification, and suitability for advanced cardiac interventions.
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