Table 2.

Suggested therapeutic recommendations for patients with cardiovascular diseases at high altitudes.

Disease	Therapeutic Options
Arterial hypertension	Replacement of non-selective beta-blockers for selective beta-blockers [52]—randomized controlled studies I C recommendation Angiotensin II receptor blockade (suggested Telmisartan) lowers BP in healthy subjects up to 3400 m—randomized controlled studies IB recommendation Regular blood pressure measurements [1]—randomized controlled studies IIA recommendation
Pulmonary hypertension	Access to oxygen during flight and trips to altitudes above 1500–2000 m a.s.l. [1,57] III and IV class patients should avoid exposure to altitudes > 2000 m, and the access to oxygen supplementation if exposed to altitudes 1500-2000 m randomized controlled studies IC recommendation
Heart failure	Replacement of non-selective beta-blockers for selective β1-blockers [1]—randomized controlled studies IB recommendation Acetazolamide [1]—among diuretics may be considered mentioned in recommendations, experts’ opinion NYHA I, NYHA II, NYHA III—patients can fly without oxygen [6]—Well-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal NYHA IV—patients should fly only in case of medical necessity [6]—Well-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal
Coronary artery disease	Continuation of the previous therapy at high altitude (1) randomized controlled studies IC recommendation NYHA I, NYHA II—patients can fly with commercial airlines [65]—Experts’ opinion NYHA III—patients may require oxygen supplementation [65]—Experts’ opinion NYHA IV—patients can fly only, when it is necessary [65]—CCS Consensus Conference
Arrhythmia	They are no restrictions for patients with well-controlled supraventricular arrhythmias classified as NYHA I or NYHA II, [65]—randomized controlled study IIA recommendation uncontrolled hemodynamically significant ventricular arrhythmias classified as NYHA III or NYHA IV—should not travel by commercial airline [1,65]—randomized controlled study IIC recommendation
Peripheral circulatory disorders	In patients with oedema caused by venous hypertension flying for more than 7 h—oral administration of beta-hydroxyethyl-rutosides [73,75]—prospective, randomized, controlled trials In patients without VTE risk factors—no need for thromboprophylaxis [79]—based on systematic reviews and meta-analyses In patients with increased risk of thrombosis—graded compression stockings or standard dose low molecular weight heparin [79]—based on systematic reviews and meta-analyses If heparin cannot be used—acetylsalicylic acid (ASA) [79], based on systematic reviews and meta-analyses
Brain vessel diseases	Trekking or hiking at high altitude ≤3 months after stroke or TIA should be avoided -randomized controlled study IC recommendation [1] Stenosis of the carotid artery and the resulting cerebral blood supply disorders—is no contraindication to flying [85]—case-control study HACE should be treated with dexamethasone; thrombolysis is not recommended (only in case of ischemic stroke) [86]—case report

VTE—venous thromboembolism, BTS—British Thoracic Society, CCS—Canadian Cardiovascular Society, NYHA—New York Heart Association, HACE—high altitude cerebral edema.