AUTHOR=Mutschler Tim , Furian Michael , Lichtblau Mona , Buergin Aline , Schneider Simon R. , Appenzeller Paula , Mayer Laura , Muralt Lara , Mademilov Maamed , Abdyraeva Ainura , Aidaralieva Shoira , Muratbekova Aibermet , Akylbekov Azamat , Shabykeeva Saltanat , Sooronbaev Talant M. , Ulrich Silvia , Bloch Konrad E. 

TITLE=Effect of altitude and acetazolamide on postural control in healthy lowlanders 40 years of age or older. Randomized, placebo-controlled trial

JOURNAL=Frontiers in Physiology

VOLUME=14

YEAR=2024

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2023.1274111

DOI=10.3389/fphys.2023.1274111

ISSN=1664-042X

ABSTRACT=<p><bold>Background:</bold> Hypoxia and old age impair postural control and may therefore enhance the risk of accidents. We investigated whether acetazolamide, the recommended drug for prevention of acute mountain sickness, may prevent altitude-induced deterioration of postural control in older persons.</p><p><bold>Methods:</bold> In this parallel-design trial, 95 healthy volunteers, 40 years of age or older, living &lt;1,000 m, were randomized to preventive therapy with acetazolamide (375 mg/d) or placebo starting 24 h before and during a 2-day sojourn at 3,100 m. Instability of postural control was quantified by a balance platform with the center of pressure path length (COPL) as primary outcome while pulse oximetry (SpO<sub>2</sub>) was monitored. Effects of altitude and treatment on COPL were evaluated by ordered logistic regression. <ext-link ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">www.ClinicalTrials.gov</ext-link> NCT03536429.</p><p><bold>Results:</bold> In participants taking placebo, ascent from 760 m to 3,100 m increased median COPL from 25.8 cm to 27.6 cm (odds ratio 3.80, 95%CI 2.53–5.70) and decreased SpO<sub>2</sub> from 96% to 91% (odds ratio 0.0003, 95%CI 0.0002–0.0007); in participants taking acetazolamide, altitude ascent increased COPL from 24.6 cm to 27.3 cm (odds ratio 2.22, 95%CI 1.57–3.13), while SpO<sub>2</sub> decreased from 96% to 93% (odds ratio 0.007, 95%CI 0.004–0.012). Altitude-induced increases in COPL were smaller with acetazolamide vs. placebo (odds ratio 0.58, 95%CI 0.34–0.99) while drops in SpO<sub>2</sub> were mitigated (odds ratio 19.2, 95%CI 9.9–37.6).</p><p><bold>Conclusion:</bold> In healthy individuals, 40 years of age or older, postural control was impaired after spending a night at 3,100 m. The altitude-induced deterioration of postural control was mitigated by acetazolamide, most likely due to the associated improvement in oxygenation.</p>