Effect of losartan on performance and physiological responses to exercise at high altitude (5035 m)

Samuel J. E. Lucas, William L Malein, Owen D Thomas, Kimberly M Ashdown, Carla A Rue, Kelsey E. Joyce, Charles Newman, Patrick Cadigan, Brian Johnson, Stephen D Myers, Fiona A Myers, Alexander D. Wright, John Delamere, Chris H E Imray, Arthur R. Bradwell, Mark Edsell

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Objective Altitude-related and exercise-related elevations in blood pressure (BP) increase the likelihood of developing pulmonary hypertension and high-Altitude illness during high-Altitude sojourn. This study examined the antihypertensive effect and potential exercise benefit of the angiotensin II receptor antagonist losartan when taken at altitude. Methods Twenty participants, paired for age and ACE genotype status, completed a double-blinded, randomised study, where participants took either losartan (100 mg/day) or placebo for 21 days prior to arrival at 5035 m (Whymper Hut, Mt Chimborazo, Ecuador). Participants completed a maximal exercise test on a supine cycle ergometer at sea level (4 weeks prior) and within 48 hours of arrival to 5035 m (10-day ascent). Power output, beat-To-beat BP, oxygen saturation (SpO 2) and heart rate (HR) were recorded during exercise, with resting BP collected from daily medicals during ascent. Before and immediately following exercise at 5035 m, extravascular lung water prevalence was assessed with ultrasound (quantified via B-line count). Results At altitude, peak power was reduced relative to sea level (p<0.01) in both groups (losartan vs placebo: down 100±29 vs 91±28 W, p=0.55), while SpO 2 (70±6 vs 70±5%, p=0.96) and HR (146±21 vs 149±24 bpm, p=0.78) were similar between groups at peak power, as was the increase in systolic BP from rest to peak power (up 80±37 vs 69±33 mm Hg, p=0.56). Exercise increased B-line count (p<0.05), but not differently between groups (up 5±5 vs 8±10, p=0.44). Conclusion Losartan had no observable effect on resting or exercising BP, exercise-induced symptomology of pulmonary hypertension or performance at 5035 m.

Original languageEnglish
Article numbere000982
JournalBMJ Open Sport & Exercise Medicine
Issue number1
Publication statusPublished - 7 Jan 2021

Bibliographical note

Funding Information:
This study was supported by the Birmingham Medical Research Expeditionary Society, which provided input for the conduct of the research. Patients were not included. Public involvement was limited to recruitment. Notification was given to participants at the time of consent that acquisition of personal data was permitted on request. Permission was also obtained at this time for the dissemination of deidentified data within the research team and only externally when a reasonable request was submitted directly to the corresponding author of the present study within 6 months of its publication. A portion of the cohort was invited to review the research methods for accuracy and readability.

Funding Information:
Funding This study was supported by a grant from the JABBS Foundation. Competing interests None declared. Patient consent for publication Not required.


  • altitude
  • cardiovascular
  • exercise
  • pulmonary

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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