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Highcare Projects HIGHCARE PROJECTS HIGHCARE HIGHCARE PROJECTS 11 YEARS OF HIGH ALTITUDE RESEARCH 11 ANNI DI RICERCA IN ALTA QUOTA This book summarizes 11 years of scientific studies conducted at high altitude on the Alps, on the slopes of Mount Everest in the Himalayas and on the peruvian Andes, by the research groups of the Italian Auxology Institute of Milan and of the University of Milano-Bicocca (Italy), directed and coordinated by Prof. Gianfranco Parati, in the context of HIGHCARE (HIGH altitude CArdiovascular REsearch) Projects. The great amount of original data so collected has allowed not only to deepen our understanding of human body responses when exposed to hypobaric hypoxia at high altitude, but also to better understand the effects of reduced oxygen availability that often characterizes patients with chronic diseases, such as heart failure, chronic obstructive pulmonary disease or severe obesity, associated with respiratory insufficiency and sleep apnea. The studies described in this volume have also evaluated the effectiveness of a range of pharmacological and non-pharmacological therapeutic interventions in counteracting the cardiovascular and systemic effects of hypobaric hypoxia. This has provided valuable information not only for the treatment of acute or chronic mountain sickness, but also for the treatment of patients with chronic diseases characterized by a reduced oxygen availability for human body organs and tissues. HIGH ALTITUDE CARDIOVASCULAR RESEARCH CARDIOVASCULAR ALTITUDE HIGH Questo libro riassume 11 anni di studi scientifici efettuati in alta quota, sulle Alpi, sulle pendici dell'Everest in Himalaya e sulle Ande peruviane, dai gruppi di ricerca dell'Istituto Auxologico Italiano di Milano e dell'Università di Milano- Bicocca nell'ambito dei Progetti HIGHCARE (HIGH altitude CArdiovascular REsearch), diretti e coordinati dal Prof. Gianfranco Parati. I numerosi ed originali dati raccolti hanno contribuito non solo ad approfondire le nostre conoscenze sulle risposte dell'organismo umano quando esposto all'ipossia ipobarica dell'alta quota, ma anche a comprendere meglio gli efetti di una ridotta disponibilità di ossigeno che spesso caratterizza pazienti con patologie croniche quali scompenso cardiaco, broncopneumopatie croniche ostruttive o obesità grave associata ad insufcienza respiratoria, e apnee nel sonno. Gli studi riassunti in questo volume hanno anche valutato l'efcacia di tutta una serie di interventi terapeutici, farmacologici e non farmacologici, nel contrastare gli efetti cardiovascolari e sistemici dell'ipossia ipobarica, ofrendo interessanti indicazioni non solo per la terapia del male acuto o cronico di montagna, ma anche per la terapia di pazienti con malattie croniche caratterizzate da una ridotta disponibilità di ossigeno per organi e tessuti. Gianfranco Parati, Andrea Giuliano, Grzegorz Bilo, Camilla Torlasco € 24,00 on behalf of the HIGHCARE investigators (IVA inclusa) “The only real voyage of discovery consists not in seeking new landscapes , but in having new eyes” “L’unico vero viaggio verso la scoperta non consiste nella ricerca di nuovi paesaggi, ma nell’avere nuovi occhi” (Marcel Proust) “Every summit you reach is nothing but an intermediate step” “Ogni cima che raggiungi non è altro che una tappa intermedia” (Seneca) “But those who are waiting for the Lord will have new strength; they will get wings like eagles: running, they will not be tired, and walking, they will have no weariness” “Ma quelli che sperano nell’Eterno saliranno con ali come aquile. Correranno e non si afaticheranno; cammineranno e non si stancheranno” (Isaia, 40:31) Never take your eyes of the goal… Dalla meta mai non torcer gli occhi.... (Alessandro Manzoni) 3 HIGHCARE PROJECTS 11 YEARS OF HIGH ALTITUDE RESEARCH 11 ANNI DI RICERCA IN ALTA QUOTA 5 HIGHCARE PROJECTS © Prof. Gianfranco Parati First published December 2014 / Prima Edizione dicembre 2014 Published by OGM - Scientific Publishing, Services & Communication P.zza San Camillo de Lellis, 1 - 20124 Milano - Tel. 02.20241664 (r.a.) - Fax 02.2043000 Authors / Autori: Gianfranco Parati, Andrea Giuliano, Grzegorz Bilo, Camilla Torlasco Art direction and graphic design / Art direction e progetto grafico: Samuele Motta Editorial coordination / Coordinamento editoriale: Margherita Parati Digital Postproduction / Postproduzione digitale: Marcel Moonen Photography / Fotografie Grzegorz Bilo, Tiziano Colombo, Andrea Faini, Andrea Giuliano, Gianfranco Parati Cover photo: The Khumbu valley In copertina: La valle del Khumbu www.highcareprojects.eu ALL RIGHT RESERVED, NO PART OF THE CONTENTS (TEXT, PHOTOS) OF THIS BOOK MAY BE REPRODUCED WITHOUT THE PERMISSION OF AUTHORS AND PUBLISHER. TUTTI I DIRITTI RISERVATI, VIETATA LA RIPRODUZIONE TOTALE E PARZIALE DEI CONTENUTI (TESTI E IMMAGINI) SENZA L’AUTORIZZAZIONE DEGLI AUTORI E DELL’EDITORE. ISBN 978-88-904646-5-2 CONTENTS INDICE 10 PREFACES PRESENTAZIONI 10 Prof. A. Zanchetti 12 Prof. G. Mancia 14 Dr. L. Festi 16 Prof. C. Messa 18 INTRODUCTION INTRODUZIONE 23 INTRODUCTION TO HIGH ALTITUDE INTRODUZIONE GENERALE ALL’ALTA QUOTA 24 Historical background Cenni storici 28 Physiology and pathophysiology of high altitude exposure Aspetti fisiologici e fisiopatologici dell’alta quota 51 HIGHCARE-ALPS 2003 - 2004 - 2005 HIGHCARE-ALPI 2003 - 2004 - 2005 52 Setting, rationale and general aims Scenario, razionale e obiettivi generali 61 HIGHCARE-ALPS 2006 HIGHCARE-ALPI 2006 62 Highcare-Alps 2006. Numbers, facts and images Highcare-Alpi 2006. Numeri, dati e immagini della spedizione 64 Setting, rationale and general aims Scenario, razionale e obiettivi generali 68 Exercise at high altitude Esercizio in alta quota 75 Blood pressure Pressione arteriosa 7 81 HIGHCARE-HIMALAYA 2008 HIGHCARE-HIMALAYA 2008 82 Highcare-Himalaya. Numbers, facts and images Highcare-Himalaya. Numeri, dati e immagini della spedizione 84 Setting, rationale and general aims Scenario, razionale e obiettivi generali 90 Blood pressure and control mechanisms Pressione arteriosa e meccanismi di regolazione 98 Alterations in arterial properties during acute and prolonged exposure to high altitude Alterazioni delle proprietà delle arterie durante esposizione acuta e prolungata in alta quota 106 Nocturnal cardio-respiratory monitoring at high-altitude Monitoraggio notturno cardiorespiratorio in alta quota 111 Changes in cardiac structure and function Variazioni nella struttura e funzione cardiaca 117 Respiratory physiology and non pharmacological interventions Fisiologia respiratoria e interventi non farmacologici 126 Modulation of hepcidin production during hypoxia-induced erythropoiesis Modulazione della produzione di epcidina durante l’eritropoiesi indotta da ipossia 131 Cognitive function under exposure to hypobaric hypoxia at altitude Funzioni cognitive in condizioni di ipossia ipobarica da alta quota 134 Changes in urinary peptidome Modulazione del peptidoma urinario 139 HIGHCARE-ALPS 2010 HIGHCARE-ALPI 2010 140 Highcare-Alps 2010. Numbers, facts and images Highcare-Alpi 2010. Numeri, dati e immagini della spedizione 142 Setting, rationale and general aims Scenario, razionale e obiettivi generali 146 Gender and acetazolamide efects on chemoreflex and periodic breathing during sleep at altitude Efetti di acetazolamide sul chemoriflesso e sul respiro periodico durante il sonno ad alta quota in maschi e femmine 153 Blood pressure Pressione arteriosa 158 Alterations in arterial properties under acute exposure to high altitude and efects of acetazolamide Alterazioni nelle proprietà delle arterie in esposizione 8 acuta ad alta quota ed efetti dell’acetazolamide 164 Cognitive alterations during acute high altitude hypobaric hypoxia exposure Alterazioni delle funzioni cognitive durante esposizione acuta ad ipossia ipobarica in alta quota 167 HIGHCARE-ANDES 2012 HIGHCARE-ANDE 2012 168 Highcare-Andes. Numbers, facts and images Highcare-Ande. Numeri, dati e immagini della spedizione 170 Setting, rationale and general aims Scenario, razionale e obiettivi generali 177 Efects of acute exposure to high altitude in patients with arterial hypertension Efetti dell’esposizione acuta ad alta quota in pazienti afetti da ipertensione arteriosa 185 Alterations in viscoelastic arterial properties in hypertensive subjects exposed to hypobaric hypoxia Alterazioni delle proprietà viscoelastiche delle arterie in soggetti ipertesi esposti ad ipossia ipobarica 188 Efects of high altitude exposure on blood pressure response to exercise in hypertensive subjects Efetti dell’esposizione ad alta quota sulla risposta pressoria all’esercizio in soggetti ipertesi 195 FUTURE PERSPECTIVES PROSPETTIVE FUTURE 196 Perspectives: Currently ongoing HIGHCARE projects Prospettive: Progetti HIGHCARE attualmente in corso 200 CONCLUSIONS CONCLUSIONI 200 High altitude exposure: a pathophysiological model of reduced oxygen availability occurring in some chronic diseases Esposizione all’alta quota: un modello fisiopatologico della ridotta disponibilità di ossigeno che si può osservare in patologie croniche 202 ACKNOWLEDGEMENTS RINGRAZIAMENTI 204 AUTHORS AUTORI 206 HIGHCARE PROJECTS RELATED PUBLICATIONS ALTRE PUBBLICAZIONI RELATIVE AI PROGETTI HIGHCARE 9 PREFACE PRESENTAZIONE It is a great pleasure to introduce the reader to È un vivo piacere introdurre il lettore al bel this beautiful volume, HIGHCARE PROJECTS, volume HIGHCARE PROJECTS, preparato prepared by Professor Gianfranco Parati and dal Prof. Gianfranco Parati e dai suoi his associates, summarizing the results of collaboratori, che riassume i risultati delle their high altitude
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