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Question addressed by the study  To investigate exercise performance and hypoxia-related health effects in patients with pulmonary hypertension (PH) during a high-altitude sojourn.    Patients and methods  In a randomised crossover trial in stable (same therapy for &gt;4 weeks) patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) with resting arterial oxygen tension ( P  aO 2  ) ≥7.3 kPa, we compared symptom-limited constant work-rate exercise test (CWRET) cycling time during a day-trip to 2500 m  versus  470 m. Further outcomes were symptoms, oxygenation and echocardiography. For safety, patients with sustained hypoxaemia at altitude (peripheral oxygen saturation  30 min or  15 min) received oxygen therapy.    Results  28 PAH/CTEPH patients (n=15/n=13); 13 females; mean± sd  age 63±15 years were included. After &gt;3 h at 2500 m  versus  470 m, CWRET-time was reduced to 17±11  versus  24±9 min (mean difference −6, 95% CI −10 to −3), corresponding to −27.6% (−41.1 to −14.1; p&lt;0.001), but similar Borg dyspnoea scale. At altitude,  P  aO 2   was significantly lower (7.3±0.8  versus  10.4±1.5 kPa; mean difference −3.2 kPa, 95% CI −3.6 to −2.8 kPa), whereas heart rate and tricuspid regurgitation pressure gradient (TRPG) were higher (86±18  versus  71±16 beats·min −1 , mean difference 15 beats·min −1 , 95% CI 7 to 23 beats·min −1 ) and 56±25  versus  40±15 mmHg (mean difference 17 mmHg, 95% CI 9 to 24 mmHg), respectively, and remained so until end-exercise (all p&lt;0.001). The TRPG/cardiac output slope during exercise was similar at both altitudes. Overall, three (11%) out of 28 patients received oxygen at 2500 m due to hypoxaemia.    Conclusion  This randomised crossover study showed that the majority of PH patients tolerate a day-trip to 2500 m well. At high  versus  low altitude, the mean exercise time was reduced, albeit with a high interindividual variability, and pulmonary artery pressure at rest and during exercise increased, but pressure–flow slope and dyspnoea were unchanged.

Effect of a day-trip to altitude (2500 m) on exercise performance in pulmonary hypertension: randomised crossover trial