高原相关高血压的发病机制及临床治疗的研究进展

刘新林, 于鑫, 郭卿

武警医学 ›› 2026, Vol. 37 ›› Issue (5) : 449-455.

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武警医学 ›› 2026, Vol. 37 ›› Issue (5) : 449-455. DOI: 10.3969/j.issn.1004-3594.2026.05.016
综述

高原相关高血压的发病机制及临床治疗的研究进展

  • 刘新林1, 于鑫2, 郭卿3
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文章历史 +

摘要

高原环境是高血压(HTN)的重要危险因素,全球尚无高原相关HTN统一定义及诊疗指南。其发病机制复杂,涉及肾上腺素能神经系统、肾素-血管紧张素-醛固酮系统等多个途径,且急性与慢性高原暴露人群的发病机制存在差异。临床治疗需区分急性与长期暴露人群制定针对性方案,急性暴露者可选用β阻滞剂、钙通道阻滞剂等药物,长期暴露者相关治疗数据匮乏。本文对高原相关HTN的发病机制及临床治疗的研究进展进行综述,旨在为临床精准防治提供支撑。

关键词

高原 / 高血压 / 发病机制 / 临床治疗

引用本文

导出引用
刘新林, 于鑫, 郭卿. 高原相关高血压的发病机制及临床治疗的研究进展[J]. 武警医学. 2026, 37(5): 449-455 https://doi.org/10.3969/j.issn.1004-3594.2026.05.016
中图分类号: R544.1   

参考文献

[1] Murray C J, Ararkin A Y, Zheng P, et al.Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet,2020,396(10258):1223-1249.
[2] Siedlinski M, Carnevale L, Xu X, et al. Genetic analyses identify brain structures related to cognitive impairment associated with elevated blood pressure[J]. Eur Heart J,2023,44(23):2114-2125.
[3] Tremblay J C, Ainslie P N. Global and country-level estimates of human population at high altitude[J]. Proc Natl Acad Sci U S A,2021,118(18): e2102463118.
[4] 中国高血压防治指南修订委员会, 中国医疗保健国际交流促进会高血压病学分会, 中国老年医学学会高血压分会,等. 中国高血压防治指南(2024年修订版)[J]. 中华高血压杂志(中英文),2024,32(7):603-700.
[5] Rimoldi S F, Sartori C, Seiler C, et al. High-altitude exposure in patients with cardiovascular disease: risk assessment and practical recommendations[J]. Prog Cardiovasc Dis,2010,52(6):512-524.
[6] Wang X Z, Bian H P, Yang L, et al. Comparison of clinical characteristics between patients with altitude-related hypertension and essential hypertension at high altitude[J]. Am J Hype,2022,35(12):1024-1025.
[7] 姚媛媛, 张 鑫, 赵丽明, 等. 高原相关高血压研究现状与展望[J]. 四川大学学报(医学版),2024,55(6):1454-1459.
[8] Mingji C, Onakpoya I J, Perera R, et al. Relationship between altitude and the prevalence of hypertension in Tibet: a systematic review[J]. Heart,2015,101(13):1054-1060.
[9] Aryal N, Weatherall M, Bhatta Y K, et al. Blood pressure and hypertension in people living at high altitude in Nepal[J]. Hypertens Res,2019,42(2):284-291.
[10] Keyes L E, Sallade T D, Duke C, et al. Blood pressure and altitude: an observational cohort study of hypertensive and nonhypertensive himalayan trekkers in nepal[J]. High Alt Med Biol,2017,18(3):267-277.
[11] Cta D, Gba D, Ag A, et al. Effects of acute exposure to moderate altitude on blood pressure and sleep breathing patterns[J]. High Alt Med Biol,2020,301:173-179.
[12] Vinueza A F, Yaulema A K, Zeeuw C I, et al. Blood pressure in andean adults living permanently at different altitudes[J]. High Alt Med Biol,2020,21(4):360-369.
[13] Dedobbeleer C, Hadefi A, Pichon A, et al. Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness[J]. Int J Cardiovasc Imaging,2015,31(4):743-752.
[14] Lundby C, Calbet J, Hall G, et al. Sustained sympathetic activity in altitude acclimatizing lowlanders and high-altitude natives[J]. Scand J Med Sci Sports,2018,28(3):854-861.
[15] Fischetti F, Fabris B, Zaccaria M, et al. Effects of prolonged high-altitude exposure on peripheral adrenergic receptors in young healthy volunteers[J]. Eur J Appl Physiol,2000,82(5-6):439-445.
[16] Parati G, Bilo G, Faini A, et al. Changes in 24 h ambulatory blood pressure and effects of angiotensin II receptor blockade during acute and prolonged high-altitude exposure: a randomized clinical trial[J]. Eur Heart J,2014,35(44):3113-3122.
[17] 储雪雁, 宋 凯, 汪永林, 等. 高血压患者血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂相关基因突变率差异的单臂Meta分析[J]. 武警医学,2025,36(3):190-196.
[18] Kamikomaki N,Nishioka O. Serum angiotensin-converting enzyme(ACE) is altered at altitude[J]. High Alt Med Biol,2004,5(4):465-466.
[19] Wang Y, Lu H, Chen Y, et al. The association of angiotensin-converting enzyme gene insertion/deletion polymorphisms with adaptation to high altitude: a meta-analysis[J]. J Renin Angiotensin Aldosterone Syst,2016,17(1):1470320315627410.
[20] Ge R L. Medical Problems of chronic hypoxia in highlanders living on the tibetan plateau[J]. High Alt Med Biol,2025,26(3):308-317.
[21] Schiffrin E L, Pollock D M. Endothelin system in hypertension and chronic kidney disease[J]. Hypertension,2024,81(4):691-701.
[22] Li H, Chen S J, Chen Y F, et al. Enhanced endothelin-1 and endothelin receptor gene expression in chronic hypoxia[J]. J Appl Physiol(1985),1994,77(3):1451-1459.
[23] Morganti A, Giussani M, Sala C, et al. Effects of exposure to high altitude on plasma endothelin-1 levels in normal subjects[J]. J Hypertens,1995,13(8):859-865.
[24] Palmo T, Abbasi B A, Chanana N, et al. The EDN1 missense variant rs5370g > t regulates adaptation and maladaptation under hypobaric hypoxia[J]. Int J Environ Res Public Health,2022,19(18): 11174.
[25] Yang B, Zhao H, Zhang J, et al. Racial differences of endothelial function and plasma endothelin 1 level in preclinical Tibetan and Han male population[J]. Eur Rev Med Pharmacol Sci,2016,20(15):3238-3243.
[26] Parati G, Revera M, Giuliano A, et al. Effects of acetazolamide on central blood pressure, peripheral blood pressure, and arterial distensibility at acute high altitude exposure[J]. Eur Heart J,2013,34(10):759-766.
[27] García L A, Carta F, Supuran C T, et al. Carbonic anhydrase, its inhibitors and vascular function[J]. Front Mol Biosci,2024,11:1338528.
[28] Vovk A, Duffin J, Kowalchuk J M, et al. Changes in chemoreflex characteristics following acute carbonic anhydrase inhibition in humans at rest[J]. Exp Physiol,2000,85(6):847-856.
[29] Bakleh M Z, Al Haj Zen A. The Distinct Role of HIF-1α and HIF-2α in Hypoxia and Angiogenesis[J]. Cells,2025,14(9): 673-678.
[30] 周志豪, 孙凡丽,江秉华. 缺氧诱导因子1在高原病中的作用机制的研究进展[J]. 四川大学学报(医学版),2024,55(6):1424-1435.
[31] Yamashita K,Discher D J, Hu J,et al. Molecular regulation of the endothelin-1 gene by hypoxia contributions of hypoxia-inducible factor-1, activator protein-1, gata-2, and p300/CBP[J]. Hypertension,2001,276(16):12645-12653.
[32] Huang Y,Lorenzo A, Jiang W, et al. Hypoxia-inducible factor-1α in vascular smooth muscle regulates blood pressure homeostasis through a peroxisome proliferator-activated receptor-γ-angiotensin II receptor type 1 axis[J]. Hypertension,2013,62(3):634-640.
[33] Tykocki N R,Watts S W. The interdependence of endothelin-1 and calcium: a review[J]. Clin Sci(Lond),2010,119(9):361-372.
[34] Taddei S, Virdis A, Ghiadoni L, et al. Lacidipine restores endothelium-dependent vasodilation in essential hypertensive patients[J]. Hypertension,1997,30(6):1606-1612.
[35] Sudano I, Virdis A, Taddei S, et al. Chronic treatment with long-acting nifedipine reduces vasoconstriction to endothelin-1 in essential hypertension[J]. Hypertension,2007,49(2):285-290.
[36] Bilo G, Villafuerte F C, Faini A, et al. Ambulatory blood pressure in untreated and treated hypertensive patients at high altitude: the high altitude cardiovascular research-andes study[J]. Hypertension,2015,65(6):1266-1272.
[37] Kono S, Stiffel V M,Gilbert R D. Effects of long-term, high-altitude hypoxia on tension and intracellular calcium responses in coronary arteries of fetal and adult sheep[J]. J Soc Gynecol Investig,2006,13(1):11-18.
[38] Agarwal R. Mechanisms and mediators of hypertension induced by erythropoietin and related molecules[J]. Nephrol Dial Transplant,2018,33(10):1690-1698.
[39] Basu M, Malhotra A S, Pal K, et al. Erythropoietin levels in lowlanders and high-altitude natives at 3450 m[J]. Aviat Space Environ Med,2007,78(10):963-967.
[40] Brar S K, Perveen S, Chaudhry M R, et al. Erythropoietin-induced hypertension: a review of pathogenesis, treatment, and role of blood viscosity[J]. Cureus,2021,13(1):e12804.
[41] Agarwal R. Erythropoietin-induced hypertension in chronic kidney disease-a mechanistic randomized controlled trial[J]. Am J Hypertens, 2025,39(3):441-451.
[42] Plata R, Cornejo A, Arratia C, et al. Angiotensin-converting-enzyme inhibition therapy in altitude polycythaemia: a prospective randomised trial[J]. Lancet.2002,359(9307):663-666.
[43] Gossmann J, Burkhardt R, Harder S, et al. Angiotensin II infusion increases plasma erythropoietin levels via an angiotensin II type 1 receptor-dependent pathway[J]. Kidney Int,2001,60(1):83-86.
[44] Lewis N C, Bailey D M, Dumanoir G R, et al. Conduit artery structure and function in lowlanders and native highlanders: relationships with oxidative stress and role of sympathoexcitation[J]. J Physiol,2014,592(5):1009-1024.
[45] Ali Z, Mishra A, Kumar R, et al. Interactions among vascular-tone modulators contribute to high altitude pulmonary edema and augmented vasoreactivity in highlanders[J]. PLoS One,2012,7(9):e44049.
[46] Kumar R, Kohli S, Ali Z, et al. CYBA(p22phox) variants associate with blood pressure and oxidative stress markers in hypertension: a replication study in populations of diverse altitudes[J]. Hypertens Res,2015,38(7):498-506.
[47] Sinha S, Ray U S, Tomar O S, et al. Different adaptation patterns of antioxidant system in natives and sojourners at high altitude[J]. Respir Physiol Neurobiol,2009,167(3):255-260.
[48] Parati G, Agostoni P, Basnyat B, et al. Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions: a joint statement by the european society of cardiology, the council on hypertension of the european society of cardiology, the european society of hypertension, the international society of mountain medicine, the italian society of hypertension and the italian society of mountain medicine[J]. Eur Heart J,2018,39(17):1546-1554.
[49] Bilo G, Caravita S, Torlasco C, et al. Blood pressure at high altitude: physiology and clinical implications[J]. Kardiol Pol,2019,77(6):596-603.
[50] Bilo G, Caldara G, Styczkiewicz K, et al. Effects of selective and nonselective beta-blockade on 24-h ambulatory blood pressure under hypobaric hypoxia at altitude[J]. J Hypertens,2011,29(2):380-387.
[51] Messerli F H, Bavishi C, Bangalore S. Why are we still prescribing angiotensin converting enzyme inhibitors?[J]. Circulation,2022,145(6):413-415.
[52] Wu T Y, Ding S Q, Liu J L, et al. Who should not go high: chronic disease and work at altitude during construction of the Qinghai-Tibet railroad[J]. High Alt Med Biol,2007,8(2):88-107.
[53] Luks A M. Should travelers with hypertension adjust their medications when traveling to high altitude?[J]. High Alt Med Biol,2009,10(1):11-15.
[54] Duo D, Zhu J, Wang M, et al. Long-term exposure to high-altitude hypoxic environments reduces blood pressure by inhibiting the renin-angiotensin system in rats[J]. Front Physiol,2025,16:1565147.

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