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Original Research: PULMONARY HYPERTENSION |

Respiratory Nitric Oxide and Pulmonary Artery Pressure in Children of Aymara and European Ancestry at High Altitude

Thomas Stuber, MD; Claudio Sartori, MD; Carlos Salinas Salmòn, MD; Damian Hutter, MD; Sébastien Thalmann, MD; Pierre Turini, MD; Pierre-Yves Jayet, MD; Marcos Schwab, MD; Céline Sartori-Cucchia; Mercedes Villena, MD; Urs Scherrer, MD; Yves Allemann, MD
Author and Funding Information

*From the Swiss Cardiovascular Center Bern (Drs. Stuber, Hutter, and Allemann), University Hospital, Bern, Switzerland; Department of Internal Medicine and Botnar Center for Extreme Medicine (Drs. Sartori, Thalmann, Turini, Jayet, Schwab, and Scherrer, and Ms. Sartori-Cucchia), University Hospital, Lausanne, Switzerland; and Instituto Boliviano de Biologia de Altura (Drs. Salinas Salmòn and Villena), La Paz, Bolivia.

Correspondence to: Yves Allemann, MD, Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland; e-mail: yves.allemann@insel.ch

†These authors contributed equally to this work.


This work was supported by grants from the Swiss National Science Foundation, the Cloëtta Foundation, the Novartis Foundation, and the Placide Nicod Foundation.

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(5):996-1000. doi:10.1378/chest.08-0854
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Invasive studies suggest that healthy children living at high altitude display pulmonary hypertension, but the data to support this assumption are sparse. Nitric oxide (NO) synthesized by the respiratory epithelium regulates pulmonary artery pressure, and its synthesis was reported to be increased in Aymara high-altitude dwellers. We hypothesized that pulmonary artery pressure will be lower in Aymara children than in children of European ancestry at high altitude, and that this will be related to increased respiratory NO. We therefore compared pulmonary artery pressure and exhaled NO (a marker of respiratory epithelial NO synthesis) between large groups of healthy children of Aymara (n = 200; mean ± SD age, 9.5 ± 3.6 years) and European ancestry (n = 77) living at high altitude (3,600 to 4,000 m). We also studied a group of European children (n = 29) living at low altitude. The systolic right ventricular to right atrial pressure gradient in the Aymara children was normal, even though significantly higher than the gradient measured in European children at low altitude (22.5 ± 6.1 mm Hg vs 17.7 ± 3.1 mm Hg, p < 0.001). In children of European ancestry studied at high altitude, the pressure gradient was 33% higher than in the Aymara children (30.0 ± 5.3 mm Hg vs 22.5 ± 6.1 mm Hg, p < 0.0001). In contrast to what was expected, exhaled NO tended to be lower in Aymara children than in European children living at the same altitude (12.4 ± 8.8 parts per billion [ppb] vs 16.1 ± 11.1 ppb, p = 0.06) and was not related to pulmonary artery pressure in either group. Aymara children are protected from hypoxic pulmonary hypertension at high altitude. This protection does not appear to be related to increased respiratory NO synthesis.

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