Sildenafil for Enhanced Performance at High Altitude?
Authors: Lewis J. Rubin, Robert Naeije
Journal: Annals of Internal Medicine (2004)

Editorials3 August 2004Sildenafil for Enhanced Performance at High Altitude?Lewis J. Rubin, MD and Robert Naeije, MDLewis J. Rubin, MDFrom University of California, San Diego, La Jolla, CA 92037, and Free University of Brussels, 1070 Brussels, Belgium. and Robert Naeije, MDFrom University of California, San Diego, La Jolla, CA 92037, and Free University of Brussels, 1070 Brussels, Belgium.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-3-200408030-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For centuries, reduced exercise tolerance at high altitudes has frustrated mountaineers and has puzzled scientists. Horace-Benedict de Saussure, who led the second ascent to Mont Blanc (altitude, 4807 m) in 1787, recorded his pulse, respirations, temperature, and symptoms and wrote:The sort of weariness which proceeds from the rarity of the air is absolutely insurmountable; when it is at its height, the most imminent peril will not make you move a step faster. … Since the air had hardly more than half of its usual density, compensation had to be made for the lack of density by the frequency of ...References1. de Saussure HB. Voyages dans les Alpes. Fauche-Borel L, ed. Neuchatel, Switzerland: Imprimeur du Roi; 1796. Cited by Houston CS. In: Going Higher. Oxygen, Man and Mountains. 4th ed. Seattle: The Mountaineers; 1998. Google Scholar2. Ward MP, Milledge JS, West JB. High Altitude Medicine and Physiology. 2nd ed. London: Chapman & Hall Medical; 1995:217-38. Google Scholar3. Fulco CS, Rock PB, Cymerman A. Maximal and submaximal exercise performance at altitude. Aviat Space Environ Med. 1998;69:793-801. [PMID: 9715971] MedlineGoogle Scholar4. Ghofrani HA, Reichenberger F, Kohstall MG, Mrosek EH, Seeger T, Olschewski H, et al . Sildenafil increased exercise capacity during hypoxia at low altitudes and at Mount Everest base camp. A randomized, double-blind, placebo-controlled crossover trial. Ann Intern Med. 2004;141:169-77. LinkGoogle Scholar5. Zhao L, Mason NA, Morrell NW, Kojonazarov B, Sadykov A, Maripov A, et al . Sildenafil inhibits hypoxia-induced pulmonary hypertension. Circulation. 2001;104:424-8. [PMID: 11468204] CrossrefMedlineGoogle Scholar6. Ghofrani HA, Schermuly RT, Rose F, Wiedemann R, Kohstall MG, Kreckel A, et al . Sildenafil for long-term treatment of nonoperable chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2003;167:1139-41. [PMID: 12684251] CrossrefMedlineGoogle Scholar7. Ghofrani HA, Wiedemann R, Rose F, Schermuly RT, Olschewski H, Weissmann N, et al . Sildenafil for treatment of lung fibrosis and pulmonary hypertension: a randomised controlled trial. Lancet. 2002;360:895-900. [PMID: 12354470] CrossrefMedlineGoogle Scholar8. Michelakis ED, Tymchak W, Noga M, Webster L, Wu XC, Lien D, et al . Long-term treatment with oral sildenafil is safe and improves functional capacity and hemodynamics in patients with pulmonary arterial hypertension. Circulation. 2003;108:2066-9. [PMID: 14568893] CrossrefMedlineGoogle Scholar9. Calbet JA, Boushel R, Radegran G, Sondergaard H, Wagner PD, Saltin B. Why is VO2 max after altitude acclimatization still reduced despite normalization of arterial O2 content? Am J Physiol Regul Integr Comp Physiol. 2003;284:R304-16. [PMID: 12388462] CrossrefMedlineGoogle Scholar10. Boushel R, Calbet JA, Radegran G, Sondergaard H, Wagner PD, Saltin B. Parasympathetic neural activity accounts for the lowering of exercise heart rate at high altitude. Circulation. 2001;104:1785-91. [PMID: 11591615] CrossrefMedlineGoogle Scholar11. Reeves JT, Groves BM, Sutton JR, Wagner PD, Cymerman A, Malconian MK, et al . Operation Everest II: preservation of cardiac function at extreme altitude. J Appl Physiol. 1987;63:531-9. [PMID: 3654411] CrossrefMedlineGoogle Scholar12. McQuillan BM, Picard MH, Leavitt M, Weyman AE. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation. 2001;104:2797-802. [PMID: 11733397] CrossrefMedlineGoogle Scholar13. Vachiery JL, McDonagh T, Moraine JJ, Berre J, Naeije R, Dargie H, et al . Doppler assessment of hypoxic pulmonary vasoconstriction and susceptibility to high altitude pulmonary oedema. Thorax. 1995;50:22-7. [PMID: 7886643] CrossrefMedlineGoogle Scholar14. Maggiorini M, Melot C, Pierre S, Pfeiffer F, Greve I, Sartori C, et al . High-altitude pulmonary edema is initially caused by an increase in capillary pressure. Circulation. 2001;103:2078-83. [PMID: 11319198] CrossrefMedlineGoogle Scholar15. Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation. 2001;104:429-35. [PMID: 11468205] CrossrefMedlineGoogle Scholar16. Boussuges A, Molenat F, Burnet H, Cauchy E, Gardette B, Sainty JM, et al . Operation Everest III (Comex '97): modifications of cardiac function secondary to altitude-induced hypoxia. An echocardiographic and Doppler study. Am J Respir Crit Care Med. 2000;161:264-70. [PMID: 10619830] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Lewis J. Rubin, MD; Robert Naeije, MDAffiliations: From University of California, San Diego, La Jolla, CA 92037, and Free University of Brussels, 1070 Brussels, Belgium.Disclosures:Consultancies: L.J. Rubin (Pfizer, Actelion, Myogen, Schering, United Therapeutics); Honoraria: L.J. Rubin (Actelion); Grants received: L.J. Rubin (Pfizer, Actelion, Myogen).Corresponding Author: Lewis J. Rubin, MD, University of California, San Diego, Medical Center, 9300 Campus Point Drive, M/C 7372, La Jolla, CA 92037; e-mail, [email protected]edu.Current Author Addresses: Dr. Rubin: University of California, San Diego, Medical Center, 9300 Campus Point Drive, M/C 7372, La Jolla, CA 92037.Dr. Naeije: Free University of Brussels, 808 Lennik Road, 1070 Brussels, Belgium. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSildenafil Increased Exercise Capacity during Hypoxia at Low Altitudes and at Mount Everest Base Camp Hossein A. Ghofrani , Frank Reichenberger , Markus G. Kohstall , Eike H. Mrosek , Timon Seeger , Horst Olschewski , Werner Seeger , and Friedrich Grimminger Metrics Cited byCon: Hypoxic Pulmonary Vasoconstriction Is not a Limiting Factor of Exercise at High AltitudeDexamethasone But Not Tadalafil Improves Exercise Capacity in Adults Prone to High-Altitude Pulmonary EdemaEchocardiographic and Tissue Doppler Imaging of Cardiac Adaptation to High Altitude in Native Highlanders Versus Acclimatized Lowlandersl -Arginine promotes angiogenesis in the chronically hypoxic lung: a novel mechanism ameliorating pulmonary hypertensionBosentan Decreases Pulmonary Vascular Resistance and Improves Exercise Capacity in Acute HypoxiaEffects of acetazolamide on aerobic exercise capacity and pulmonary hemodynamics at high altitudesEffects of Sildenafil on Exercise Capacity in Hypoxic Normal SubjectsBiventricular Function at High Altitude: Implications for Regulation of Stroke Volume in Chronic HypoxiaRight and left ventricular adaptation to hypoxia: a tissue Doppler imaging studyTreatment of Pulmonary Hypertension Related to Disorders of HypoxiaSildenafil voor meer prestatie op grote hoogte en lager? 3 August 2004Volume 141, Issue 3Page: 233-235KeywordsCardiac outputCyclic adenosine monophosphateExerciseHeart rateHypoxiaMaximum oxygen consumptionOxygenPulmonary arteriesPulmonary hypertensionVasoconstriction ePublished: 3 August 2004 Issue Published: 3 August 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. 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