In community-dwelling older adults residing in lowland to mid-elevation zones (35–1289 m) of Xinjiang, the prevalence and risk of hypertension were found to be inversely associated with residential altitude.
Hypertension prevalence was inversely associated with altitude across the three study sites.
After multivariable adjustment, residing at lower altitudes was associated with significantly increased odds of hypertension compared to the highest-altitude site.
Mean systolic and diastolic blood pressure varied significantly across the three altitude sites.
Sex-stratified analyses showed statistically significant differences in SBP and DBP distributions across altitudes for both males and females.
Age-stratified analyses showed significant differences in SBP and DBP across altitudes in all age groups except those aged ≥90 years.
The inverse association between altitude and blood pressure was consistent across multiple subgroups defined by lifestyle and clinical factors.
The authors note that the observed inverse altitude–hypertension association likely reflects altitude-related environmental factors rather than direct physiological effects of hypoxia.
The study used a cross-sectional design with multistage stratified sampling across three cities in Xinjiang, China.
This research suggests that among older adults living in northwest China, people residing at lower elevations were more likely to have high blood pressure (hypertension) than those living at higher elevations. The study surveyed over 50,000 adults aged 60 and older across three cities at different altitudes — Turpan (nearly at sea level), Hami (738 meters), and Kashgar (1,289 meters) — and found hypertension rates of roughly 55%, 50%, and 41% respectively. Even after accounting for differences in age, sex, smoking, alcohol use, body weight, diabetes, and other health factors, people at the lower-altitude sites were up to 80% more likely to have hypertension compared to those at the highest site. This finding is notable because it runs counter to what some previous research has suggested about very high altitudes — where low oxygen levels can raise blood pressure. In this mid-to-low altitude range (35 to 1,289 meters), altitude appears to be associated with lower blood pressure risk, not higher. The researchers suggest this pattern is more likely driven by environmental or lifestyle factors tied to altitude — such as climate, diet, or temperature — rather than by the body's direct response to reduced oxygen levels. This research suggests that where people live, even within a relatively modest range of altitudes, may matter for cardiovascular health in older populations. However, the study is cross-sectional (a snapshot in time) and was conducted in a specific region and ethnic context, so the findings may not apply everywhere. Additional studies are needed to understand the specific environmental or biological mechanisms linking altitude to blood pressure in this altitude range.
Maimaitiwusiman Z, Xuekelati S, Wumaier A, Bai X, Ma L, Li Y, et al.. (2026). Hypertension and altitude in community-dwelling older adults: an epidemiological study in northwest China.. BMJ open. https://doi.org/10.1136/bmjopen-2025-102957