Key result
Intermittent hypoxia-hyperoxia exposure safely lowers post-session systolic BP by ~6 mmHg in heart failure patients.
Why the study?
HFpEF and HFrEF cause substantial global burden with limited therapeutic options, particularly for HFpEF, and the safety and efficacy of an individualised intermittent hypoxia-hyperoxia exposure (IHHE) program in these patients required evaluation.
Does a 10-week individualised intermittent hypoxia-hyperoxia exposure program improve safety, exercise capacity, and quality of life in outpatients with HFpEF and HFrEF?
Does a 10-week individualised intermittent hypoxia-hyperoxia exposure program improve safety, exercise capacity, and quality of life in outpatients with HFpEF and HFrEF?
A 10-week intermittent hypoxia-hyperoxia exposure program was safe and feasible in heart failure patients, demonstrating significant improvements in blood pressure and body composition alongside non-significant trends toward improved exercise capacity.
Background Heart failure with preserved (HFpEF) and reduced (HFrEF) ejection fraction causes substantial global burden with limited therapies, especially for HFpEF. This pilot study assessed safety and efficacy of a 10-week individualised intermittent hypoxia–hyperoxia exposure (IHHE) program, hypothesising good tolerability and improvements in exercise capacity and quality of life (QoL). Methods In this prospective mechanistic feasibility study, HFpEF and HFrEF patients completed supervised seated IHHE sessions three times weekly for 10 weeks using a medical altitude breathing device. Blood pressure (BP) was monitored before and after sessions. Pre- and post-intervention assessments included echocardiography, cardiopulmonary exercise testing (CPET), 6-minutes walking test (6MWT), isokinetic muscle strength, body composition, biomarkers, patient-reported outcomes, and clinically indicated right heart catheterization (RHC). Results Nine outpatients (5 HFpEF, 4 HFrEF; age 66.6±10.9 years, 22% female, BMI 27.9±5.4 kg/m²) completed the study. IHHE was safe and well tolerated (adherence 95%), with no adverse events. Across weeks 1–10, post-session reductions in systolic (β =−5.95 mmHg) and diastolic blood pressure (β=−3.74 mmHg), and heart rate (β=−5.18 bpm) were measured (all p< 0.001). A significant decrease of fat mass index 9.32±2.56 vs. 8.92±2.41 kg/m² (P=0.031), and visceral fat area 127.6±30.6 vs. 121.9±29.7 cm² (P=0.005), as well as an increase of body mineral content 3.14±0.57 vs. 3.21±0.55 kg (P=0.028), and tissue impedance (RB250: 4.02±0.50 vs. 4.12±0.56 kHz, P=0.041), were measured. Additionally, there was a numeric improvement (not statistically significant) of peak VO2 (~+300 mL/min), 6MWT (+22 m), and right quadriceps peak torque. RHC showed no adverse acute hemodynamic effects, while invasively measured left ventricular systolic pressure decreased during hypoxia. No changes in QoL were observed. Conclusion Ten-week IHHE was safe and feasible in HF patients and led to improved BP and body composition and showed trends toward better exercise capacity. Larger randomised trials are needed to confirm these results.Central figure
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Bekfani et al. (2026) studied Heart failure (HFpEF and HFrEF) (n=9). Individualised intermittent hypoxia–hyperoxia exposure (IHHE) vs. Pre-intervention baseline (single-arm study) was evaluated on Safety, tolerability, post-session blood pressure, body composition, exercise capacity, and quality of life (β -5.95 mmHg (systolic BP), p=<0.001). Ten-week intermittent hypoxia-hyperoxia exposure was safe (95% adherence, 0 adverse events) and reduced post-session systolic BP (β=-5.95 mmHg, p<0.001) and visceral fat area (p=0.005) in HF patients.
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