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First, Alteration of Cardiopulmonary Functions Along with Altitude From FFiirsrst,t, AAllteteraratitioonn ooff ccaardrdiiooppuullmmoonnaaryry fufunncctitioonnss aalloonngg wwiithth aalltititutuddee frofromm 33225500mm toto 44664477mm Subjects • The neuro-cardio-pulmonary • Ladakhi subjects living function, including the Kohs at different altitudes block design test, the Up & (Phey village, 3250 m: Go, the Functional Reach 17 men and 55 women; and the Button tests, was Chumathang village, examined 4193 m: 29 men and 47 women; Sumdo village, 4540 m: 38 men and 57 women; and Korzok village, 4647 m: 84 men and 70 women). Result : cardiopulmonary functions among the 5 villages, including Leh at 3524 m • The average age of residents of • The average of SpO2 both genders decreased with decreased with altitude altitude (p<0.0005). (p<0.0001) . 80 100 70 60 90 50 2 e 40 O g a A 30 S 80 20 10 70 0 S P C S K S P C S K c h h u a c h h u a h e u m t h e u m t o y m d z o y m d z Result : cardiopulmonary functions among the 5 villages, including Leh at 3524 m • Diastolic BP increased with altitude. By contrast, systolic BP did not correlate with altitude. 110 Men Women 100 P B 90 c i l o t s 80 a i D 70 60 m m m m m m m m m m 3 7 0 7 7 3 0 0 7 0 9 5 5 4 5 9 4 4 4 5 1 3 2 3 6 2 1 5 6 5 p<0.0001 4 3 3 4 3 4 4 3 4 4 Result : cardiopulmonary functions among the 5 villages, including Leh at 3524 m 24 22 p<0.0001 • Hb increased with altitude. 20 18 16 b 14 • Height, weight and BMI H 12 10 decreased with altitude in 8 both genders. 6 S P C S K c h h u a 80 30 h e u m t p<0.0001 p<0.0001 o y m d z t 70 25 h 60 g I i 50 20 e M 40 B W 15 30 20 10 S P C S K S P C S K c h h u a c h h u a h e u m t h e u m t o y m d z o y m d z Discussion 5 towns at different altitudes %# Hb y = -0.1446x + 28.337 • Altitude was found to $! R = -0.267 (g/dl) affect neuro-cardio- $# pulmonary functions in "! Ladakh, India. "# • At high altitude, SpO2 p<0.001 ! decreased, whereas Hb &# '# (# )# "## and diastolic BP DBP increased with altitude. (mmHg) p<0.001 • Residents of both genders were younger and leaner at higher y = -0.4963x + 127.85 altitude. R = -0.202 60 70 80 90 100 SaO2 (%) SSeeccoonndd,, AAllteteraratitioonn ooff ccaardrdiiooppuullmmoonnaaryry fufunncctitioonnss bbeetwtweeeenn LLaaddaakkhh ((33552244mm)) aanndd TToossaa((2255mm)) Subjects • in 40 elderly subjects (19 men and 21 women, mean age: 74.7±3.3 years) in Leh, Ladakh (altitude: 3524 m), • for comparison with 324 elderly citizens (97 men and 227 women, mean age: 80.7±4.7 years) of Tosa, Japan (altitude: 250 m). Methods • Oxygen saturation (SpO2), respiration rate at rest and several cardiovascular variables, including BP, HR, conventional 12-lead ECG, and • PWV was measured between the right arm and ankle in a supine • BP was measured 6 times position, using a VaSera (twice in a sitting, twice in CAVI instrument (Fukuda a supine and twice in a Denshi Co., Ltd., Tokyo, Japan). standing position). Methods • The Up & Go test measured, • This test is a simple in seconds, the time it took measure of physical the subject to stand up from mobility and a chair, walk a distance of 3 demonstrates the meters, turn, walk back to the subject’s balance, gait chair, and sit down again. speed, and functional ability. • A lower time score indicates a better physical mobility. Methods • Functional Reach, used to evaluate balance, represents the maximal distance a subject can reach forward beyond arm’s length while maintaining a fixed base of support in the standing position. • A higher score indicates a better balance. Methods • Manual dexterity was • The total manual dexterity assessed using a panel time in seconds, defined with combinations of 10 as the button score hooks, 10 big buttons, (Button), was calculated and 5 small buttons. by adding the average There were three discrete times for one hook-on measurements of time and one big or small recorded for each button-on-and-off. participant (10 “hook-on” • A lower button score s, 10 big “button-on-and- indicates a better manual off”s, and 5 small “button- dexterity. on-and-off”s). Methods • The Kohs block design test and time estimation test were used to assess the overall cognitive function. Result : comparison of neuro-cardio-pulmonary function between elderly citizens in high and low altitude towns • All 6 measurements of Leh Tosa p-value diastolic BP and 5 of the 6 HR Age 74.7 80.7 <0.0001 measurements were BMI 23.8 24.4 N.S. statistically SBP S1 155.7 153.4 N.S. significantly higher in DBP S1 91.0 87.3 0.05 Leh than in Tosa. Pulse S1 76.4 70.4 <0.005 Incr in HR起 with立性 脈stand拍増 13.8 9.9 <0.001 • Changes in HR from Up & Go 15.0 17.6 N.S. the supine to the Kohs 9.0 16.4 <0.0001 standing position were TE10-1 8.5 11.5 <0.005 larger in Leh than in TE10-2 7.9 10.0 <0.01 Tosa (13.8 ± 8.1 bpm vs. 9.9 ± 6.7 bpm, TE60-1 42.7 57.1 <0.0005 p<0.001). TE60-2 38.3 55.4 <0.0001 SpO2 88.0 96.6 <0.0001 Respiration 21.1 17.8 <0.0001 Result : comparison of neuro-cardio-pulmonary function between elderly citizens in high and low altitude towns 100 p<0.00001 • In Leh at 3524 m, $ 95 % elderly residents had $ # 90 a lower SpO2 and a " higher respiration rate ! 85 , + ( * than elderly Japanese ' & 80 ) residents in Tosa * ) 30 (SpO2: 88.0 ± 4.3 % % ( p<0.00001 vs. 96.6 ± 1.2 %, ' & 20 p<0.0001; RR: 21.1 ± % 4.2 vs. 17.8 ± 4.2, $ # p<0.0001). " 10 ! ' # , ) " + 0 - High-altitude (3524 m) people showed a steeper increase in BP with age than low-altitude (25 m) people 240 " 220 ! Uraus " Ladak & 200 " " " % " " " 180 " " ! ! " $ " " " " " " ! " " "" ! " !"!" " "" ! " ! !" " " 160 " " " !! !!"""" " " ! "! " "! "" " " ""!"!""!" !!" ""!"" " "!" !!!"!" """!"!!! !" " "!"""! " !"!""!!"!"""!" !!!" "! "! 140 "" " " """ "!"!"""!"!"!! ! ! " "" " "" "!"!!"!"!""!!"!!"!!"""!!!!" !!!"! " " "" !""" "!" !!"" !!" ""!!!!!!!!"!!! " !"! " !" " !"!""! "!!"!!""!"! "! ! ! "" ! " """ !""""!!"!!!""!"!"!"!!!!!!! "" " 120 " "" "" !""!!!!!" "!"!!"!!""!""!! ! !""""""""!""" !""! "!"!!""!!"!"!"!"!! ! " " " """"!"""!" """!"!"!"!""!""!"!"!!" ! ! !"""!"""!"!""""" !"!" "! ""! ! ! "! "" ""!" " " 100 "" " " " " ! ! " " " " Slope: 80 " # 0.317 vs. 0.747 10 20 30 40 " 50 60 70 80 ! (P<0.0005) High-altitude (3524 m) people showed a steeper increase in BP with age than low-altitude (25 m) people Several reasons may account for the difference. ! First, at higher altitude, atmospheric oxygen is lower; hypoxemia stimulates sympathetic nerve activity, which is associated with an increase in BP and HR. ! Second, Ladakh is a cold desert and its environmental temperature drops as low as -45b in winter, whereas in summer, the temperature reaches up to 27b, a factor that will also stimulate sympathetic activity and increase BP. High-altitude (3524 m) people showed a steeper increase in BP with age than low-altitude (25 m) people ! Third, it has been reported that salt intake in Ladakh people is larger than in Japanese, which may result in an exaggerated increase in syst. and diast. BP with age, compared to Japanese people . (A report lists urinary sodium values (in nmol/24h) of 209.1 and 198.2 for males and females in Ladakh, as compared to 191.0 and 145.6 for males and female in Osaka.) High-altitude (3524 m) people showed a steeper increase in BP with age than low-altitude (25 m) people ! Fourth, ACE (angiotensin-converting-enzyme) gene I/D polymorphism is reportedly associated with high-altitude disorders. It is also speculated that this polymorphism may be related to the larger increase in BP with age observed herein. ! Fifth, medical services are only now developing in Ladakh, and citizens do not have sufficient access to medicines. ! Sixth, poverty in Ladakh people is such that delivery of electric power is insufficient. High-altitude (3524 m) people showed a steeper increase in BP with age than low-altitude (25 m) people ! Lastly, Leh, the capital of Ladakh, was once the central meeting-point for trade caravans from Central Asia and the plains of India. The main religion is Tibetan Buddhism and many monks practice it in its original form. Cultural differences between Ladakh and Japan may also contribute to the differences in the effect of aging on BP. SpO2 & BP Ladakh citizens at high altitude SBP $%%Relationship y= 232 - 1.2 x between SpO2 & BP in citizens, at high altitude of 3524 m, in Ladakh $%%Citizens of the lower SpO2 show higher systolic BP. SpO2 (n=197, r=-0.207, p<0.01) SpO2 & PWV (CAVI)%Ladakh citizens Citizens of the lower SpO2 show the larger PWV. Chronic hypoxia induces elevated BP, and advanced atherosclerosis. y = 16.2-0.093x (n = 197, r = -0.293, p<0.0005) Conclusion & Discussion • Adaptation to high • The present study also altitude was confirmed in showed that the cognitive the thorough investigation function (estimated by the in Leh. Kohs block design test) and ADL functions • Diastolic, but not systolic, (scored by the Functional BP was higher, and the Reach and Button tests) increase in HR with were worse at high than postural change from the at low altitude.
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