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The question addressed by the study  Chronic exposure to hypoxia increases pulmonary artery pressure (PAP) in highlanders, but the criteria for diagnosis of high-altitude pulmonary hypertension (HAPH) are debated. We assessed cardiac function and PAP in highlanders at 3250 m and explored HAPH prevalence using different definitions.    Patients and methods  Central Asian highlanders free of overt cardiorespiratory disease, permanently living at 2500–3500 m compared to age-matched lowlanders living &lt;800 m. Participants underwent echocardiography close to their altitude of residence (at 3250 m  versus  760 m).    Results  173 participants (97 highlanders, 76 lowlanders), mean± sd  age 49±9 years (49% females) completed the study. Results in lowlanders  versus  highlanders were systolic PAP (23±5  versus  30±10 mmHg), right ventricular fractional area change (42±6%  versus  39±8%), tricuspid annular plane systolic excursion (2.1±0.3  versus  2.0±0.3 cm), right atrial volume index (20±6  versus  23±8 mL·m −2 ), left ventricular ejection fraction (62±4%  versus  57±5%) and stroke volume (64±10  versus  57±11 mL); all between-group comparisons p&lt;0.05. Depending on criteria, HAPH prevalence varied between 6% and 35%.    The answer to the question  Chronic exposure to hypoxia in highlanders is associated with higher PAP and slight alterations in right and left heart function compared to lowlanders. The prevalence of HAPH in this large highlander cohort varies between 6% according to expert consensus definition of chronic high-altitude disease to 35% according to the most recent definition of pulmonary hypertension proposed for lowlanders.

Cardiac function and pulmonary hypertension in Central Asian highlanders at 3250 m