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High Altitude Pulmonary HypertensionNCT05107700

Altitude Related Adverse Health Effects (ARAHE) in Patients With Precapillary Pulmonary Hypertension During 30h Exposure to 2500m

A study testing Stay at altitude 2500 m above sea level (high altitude) and Stay at altitude 470 m above sea level (low altitude) in people with High Altitude Pulmonary Hypertension, run by University of Zurich at 1 site in Switzerland.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The interest of journeys to high altitude regions for recreational or professional purposes is increasing, also among potentially vulnerable groups including patients with chronic cardiopulmonary diseases such as pulmonary hypertension (PH). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
High Altitude Pulmonary Hypertension
What is being tested?
Stay at altitude 2500 m above sea level (high altitude) and Stay at altitude 470 m above sea level (low altitude)
Type of treatment
Surgery or procedure
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
28 participants
Where
1 siteSwitzerland
Study dates
18 Oct 2021to 15 Apr 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Informed consent as documented by signature
  • PH class I (PAH) or IV (CTEPH) diagnosed according to guidelines: mean pulmonary artery pressure >20 mmHg, pulmonary vascular resistance ≥3 wood units, pulmonary arterial wedge pressure ≤15 mmHg during baseline measures at the diagnostic right-heart catheterization

Who cannot join

  • Resting partial pressure of oxygen <8 kilopascal at Zurich at 490 m low altitude
  • Exposure to an altitude >1000 m for ≥3 nights during the last 2 weeks before the study
  • Inability to follow the procedures of the study
  • Other clinically significant concomitant end-stage disease (e.g., renal failure, hepatic dysfunction)

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • University Hospital of Zurich

    Zurich, 8091

Other trials in Switzerland

About this study

Official title: The Impact of Hypoxia on Patients With Precapillary Pulmonary Hypertension and Treatment of Adverse Effects

The interest of journeys to high altitude regions for recreational or professional purposes is increasing, also among potentially vulnerable groups including patients with chronic cardiopulmonary diseases such as pulmonary hypertension (PH). In Switzerland and many other regions worldwide, many settlements and alpine resorts are at altitudes above 1500m and alpine tourism is an important social and economic sector. However, the hypoxic environment at altitude may induce altitude related adverse health effects (ARAHE), including hypoxemia, symptoms of acute mountain sickness (AMS), reduces exercise capacity and increases the pulmonary arterial pressure, which is of particular relevance for patients with chronic hypoxemic respiratory diseases including PH.

On the other hand, advances in disease-targeted medical combination therapies renders PH to the chronic disease groups with many patients surviving for many years with a relatively good quality of live, exercise capacity and low symptom burden. However, data on ARAHE and the exercise capacity of patients with pre-existing PH at altitude is scarce, so that current expert-based guidelines discourage altitude travel for patients with PH. However, we previously showed that the majority of stable PH-patients tolerates normobaric hypoxia or a short trip to 2500m well.

Read more

With this project we aim to get profound clinical and pathophysiological insights into the effects of the hypobaric hypoxic environment at altitude during an overnight stay up to 30 hours on the incidence of ARAHE needing oxygen therapy, exercise capacity, pulmonary hemodynamics and sleep in patients with precapillary PH.

We hope that this new valuable data will provide a basis to better counsel PH-patients for potential risk of altitude sojourns.

Read the detailed description

Background:

Precapillary PH is defined by right heart catheterization as mean PAP (mPAP) >20 mmHg, pulmonary artery wedge pressure (PAWP) ⩽15 mmHg along with a pulmonary vascular resistance (PVR) ⩾3 wood units (WU). PH is classified into five major groups according to the clinical presentation and response to vasodilator therapies. In the absence of predominant lung disease, the major precapillary PH forms are pulmonary arterial and chronic thromboembolic PH that are the main pulmonary vascular diseases and hereafter summarized as PH.

The leading symptom in PH is dyspnoea on exertion, impaired exercise performance, daily activity and quality of life.With progression of the disease, worsening hemodynamics may lead to gas exchange disturbances associated with hypoxemia, particularly during exercise and sleep. For a long time, the occurrence of PH was associated with a dismal prognosis progressively leading to right heart failure and death within months to a few years. Although PH is still incurable, recent therapeutic advances including medical or interventional therapies have improved the life expectancy, physical performance and quality of life of PH-patients and many patients seen in our daily practice wish to near-normally participate in professional work and recreational activities.

Globally, leisure time and professional activities at high altitude become increasingly popular exposing millions of people to hypobaric hypoxia annually. The alpine tourism in Europe and in other regions worldwide has a long lasting tradition and a relevant number of people have chosen their resident above 1500m above sea level.

Travel to high altitude and altitude-related adverse health effects (ARAHE):

Many Swiss villages and tourist resorts are located at altitudes between 1000 - 2500 m. In America, Asia and Africa, even large settlements are located at these or even higher altitudes and it is estimated that more than 50 million people permanently live above 2500 m. Accordingly, worldwide, millions of people travel regularly to mountain areas for business or recreation and expose themselves to hypobaric hypoxia during days to weeks or even longer. In addition, traveling by airplane, which has become extremely popular, further increased the number of people that are exposed to a hypoxic environment, as the minimally allowed cabin pressure in commercial air travel is equivalent to 2430 m (8000 ft) of altitude and this is often reached in intercontinental flights.

In healthy individuals, altitude exposure acutely induces hyperventilation by hypoxic chemoreceptor stimulation. This mitigates hypoxemia but promotes sleep disturbing high-altitude periodic breathing. About 50% of lowlanders ascending rapidly to >3000 m suffer from acute mountain sickness (AMS) causing headache, loss of appetite, weakness, fatigue and general discomfort. If AMS is not treated by descent, oxygen or medication, it may progress to life-threatening high altitude cerebral oedema. Furthermore, hypoxic pulmonary vasoconstriction (HPV) leads to an elevated PAP at altitude. In 2-4% of mountaineers climbing to 4559 m, excessive PAP-increase triggers high altitude pulmonary edema (HAPE), a non-cardiogenic pulmonary oedema associated with profound, potentially life-threatening hypoxemia, which is treated by oxygen therapy and may be prevented by phosphodiesterase type-5 inhibitor (PDE5i) administration or dexamethasone.

Contribution of this project to the gap in knowledge of the effects of hypoxia in PH:

The proposed trials will provide novel, robust data on the clinical and pathophysiological effects of exposure to a hypoxic environment in patients with PAH/CTEPH. This study will evaluate for the first time safety and tolerability of altitude exposure including an overnight stay in PH-patients and the effect of supplemental oxygen to reverse ARAHE. Close monitoring of patients including during exercise and sleep will provide insight into hypoxia-induced physiological mechanisms and the time course of altitude adaptation. Due to the special geographical location of Switzerland, we have the unique opportunity to study the response to hypobaric hypoxia in patients with PH in excellently suitable and safe settings in the nearby mountains and provide this important data to the scientific community worldwide for the benefit of many PH-patients and their advising caregivers.

Being tested
Stay at altitude 2500 m above sea level (high altitude), Stay at altitude 470 m above sea level (low altitude)
Medical subject headings
Pulmonary edema of mountaineers

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Stay at altitude 2500 m above sea level (high altitude)Procedure or surgery

    Patients with precapillary pulmonary hypertension stay a sojourn of 30 h at 2500 m.

  • Stay at altitude 470 m above sea level (low altitude)Procedure or surgery

    Patients with precapillary pulmonary hypertension stay a sojourn of 30 h at 470 m.

Study groups in NCT05107700
Study groupRoleWhat they receive
Start with: Stay at altitude 2500 m above sea level (high altitude)ExperimentalPatients with precapillary pulmonary hypertension stay a sojourn of 30 h at 2500 m.
Receives: Procedure: Stay at altitude 2500 m above sea level (high altitude); Procedure: Stay at altitude 470 m above sea level (low altitude)
Start with: Stay at altitude 470 m above sea level (low altitude)Placebo comparatorPatients with precapillary pulmonary hypertension stay a sojourn of 30 h at 470 m as comparator.
Receives: Procedure: Stay at altitude 2500 m above sea level (high altitude); Procedure: Stay at altitude 470 m above sea level (low altitude)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of altitude-related adverse health effects (ARAHE as defined below) during a sojourn at 2500m, time frame up to 30 h. ARAHE will be defined by any of the following criteria:

    • Acute mountain sickness with a Lake Louise score >4 including headache, or AMSc score ≥0.7
    • severe hypoxemia defined as: resting SpO2 <75% for >15 min or <80% for >30 min; exercise SpO2 <75% for >5 min and/or criteria for stopping exercise according to guidelines
    • intercurrent illness: infection, neurologic, impairment, other new diseases/accidents, requiring medical treatment other than simple measures such as paracetamol
    • chest pain and/or ECG signs of cardiac ischemia, syncope, tachy- or bradyarrhythmia, severe hyper- or hypotension accompanied by symptoms
    • dyspnoea at rest and/or any discomfort requiring treatment and/or leading to the wish of a patient to return to low altitude or withdraw from the study

    Measured: 30 hours

Secondary outcomes (9)
  1. Components of altitude-related adverse health effects

    Incidence of individual components of altitude-related adverse health effects

    Measured: 30 hours

  2. Severity of symptoms

    Severity of symptoms of acute mountain sickness at 2500 m of high altitude measured by the Lake louise score (LLS) (or Acute Mountain Sickness c questionnaire)

    Measured: 30 hours

  3. Difference in pulmonary artery pressure

    Difference in pulmonary artery pressure assessed by the transtricuspid pressure gradient at rest by echocardiography at high vs. low altitude

    Measured: 30 hours

  4. Difference in pulmonary vascular resistance assessed

    Difference in pulmonary vascular resistance assessed by the transtricuspid pressure gradient at rest by echocardiography at high vs. low altitude

    Measured: 30 hours

  5. Difference in right ventricular function

    Difference in right ventricular function impairment by echocardiography at high vs. low altitude

    Measured: 30 hours

  6. Resting electrocardiography

    Prevalence of abnormal resting electrocardiographies (ECG) at high altitude vs. low altitude

    Measured: 30 hours

  7. Exercise electrocardiography

    Prevalence of abnormal exercise electrocardiographies (ECG) at high altitude vs. low altitude

    Measured: 30 hours

  8. Blood pressure

    Difference in blood pressure at high vs. low altitude

    Measured: 30 hours

  9. Heart-rate variability

    Difference in heart-rate variability at high vs. low altitude

    Measured: 30 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Nov 2021
  2. Study start18 Oct 2021
  3. Primary completion15 Apr 2022
  4. Study completion15 Apr 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Screening
Allocation
Randomised
Intervention model
Crossover
Masking
None (open label)
Enrolment
28 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05107700
Sponsor's protocol ID
OVERALP II A
Status last verified
May 2022
First submitted
12 Oct 2021
Last updated
11 May 2022
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Muller J, Schneider SR, Bauer M, Mayer L, Furian M, Lichtblau M, Ulrich S. The Effect of a 2-Day Stay at High Altitude (2,500 m) on Right Ventricular Afterload and Oxygen Delivery in Patients With Pulmonary Vascular Disease: A Randomized Controlled Crossover Trial. Chest. 2026 Jul 3:S0012-3692(26)00925-6. doi: 10.1016/j.chest.2026.06.032. Online ahead of print.

    PubMed 42398808
  • Muller J, Mayer L, Schneider SR, Bauer M, Furian M, Bloch KE, Schwarz EI, Lichtblau M, Silvia U. Pulmonary haemodynamics and right heart function during exercise at high versus low altitude in patients with pulmonary vascular disease: a randomised crossover trial. Heart. 2025 Dec 11;112(1):28-36. doi: 10.1136/heartjnl-2024-325605.

    PubMed 40404280
  • Schneider SR, Muller J, Bauer M, Mayer L, Luond L, Ulrich T, Furian M, Forrer A, Carta A, Schwarz EI, Bloch KE, Lichtblau M, Ulrich S. Overnight exposure to high altitude in pulmonary hypertension: adverse events and effect of oxygen therapy. Eur Heart J. 2024 Jan 27;45(4):309-311. doi: 10.1093/eurheartj/ehad789. No abstract available.

    PubMed 38079468

Questions about this trial

What is this clinical trial studying?

A study testing Stay at altitude 2500 m above sea level (high altitude) and Stay at altitude 470 m above sea level (low altitude) in people with High Altitude Pulmonary Hypertension, run by University of Zurich at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 May 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of altitude-related adverse health effects (ARAHE as defined below) during a sojourn at 2500m, time frame up to 30 h. ARAHE will be defined by any of the following criteria: (time frame: 30 hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05107700, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 May 2022.

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