“…However, results of several empirical and theoretical studies suggest that increasing the Hb concentration of partially saturated blood is not an ideal long-term solution to the problem of chronic hypoxemia because the associated increase in blood viscosity produces an elevated peripheral vascular resistance that can compromise cardiac output (Guyton and Richardson, 1961;Bullard, 1972;McGrath and Weil, 1978;Winslow and Monge, 1987;Monge and León-Velarde, 1991;Connes et al, 2006;Schuler et al, 2010;Storz, 2010). Studies of humans at high altitude have suggested that the optimal Hb concentration at rest and at exercise may actually be quite close to the typical sea level value (Winslow, 1988;Villafuerte et al, 2004), or perhaps only slightly higher (Reeves and León-Velarde, 2004), and it is well documented that excessive polycythemia is a causal factor in the development of chronic mountain sickness (Winslow et al, 1985;Winslow and Monge, 1987;Monge and León-Velarde, 1991;Rivera-Ch et al, 2007).…”