Abstract: High altitude pulmonary hypertension (HAPH) is a common and severe cardiopulmonary disease in high altitude regions. Traditional research has primarily focused on the effects of hypoxic environments on pulmonary vessels. However, recent studies have shown that, in addition to hypoxia, high altitude specific non-hypoxic co-factors, such as dust pollution and extreme low temperatures, also play significant roles in pulmonary vascular injury and the development of HAPH. The particulate matter and harmful components in high-altitude dust can induce inflammatory responses and oxidative stress in pulmonary vessels, while extremely low temperature exacerbates pulmonary artery pressure through vasoconstriction and metabolic disorders. This article summarizes and analyzes the mechanisms through which these two non-hypoxic factors affect pulmonary vascular structure and function, explores their synergistic effects in the pathogenesis of HAPH, and reviews the existing intervention strategies and their limitations. By synthesizing the latest research findings, this article aims to provide scientific evidence for the multi-factorial prevention and treatment of HAPH in high altitude areas and promote the development of more effective preventive and therapeutic approaches.