We studied the influence of a 3-week hiking vacation at moderate altitude on cardiac pump and endocrine function. 18 males (mean age: 55 years, range 36-60) with metabolic syndrome participated in a 3-week structured guided hiking vacation program (4 times per week at 55-65% of maximal heart rate, total exercise time 29 h). Echocardiography, B-type natriuretic peptide (BNP), NT-proBNP, and endothelin-1 measurements were performed at baseline in Innsbruck (576 m a.s.l., Austria), on the first day at moderate altitude (Obertauern, 1700 m a.s.l., Austria), after 3 weeks in Obertauern, and at follow-up in Innsbruck. We found no adverse cardiovascular effects and no significant changes in echocardiographic measures of systolic or diastolic function, estimated systolic pulmonary artery pressure, exercise capacities, BNP and NT-proBNP, or endothelin-1 concentrations. The blood pressure at rest significantly decreased from baseline to follow-up.