<p>The mechanical properties and durability of concrete in high-altitude regions are adversely affected by unfavorable climatic conditions, including low air pressure, low humidity, low temperatures, large temperature differences, and strong winds. These conditions accelerate the moisture evaporation, deteriorate the air-void structure, delay strength development, and increase the risk of surface cracking and scaling in concrete. We conduct a detailed review of the influencing factors, extent, and mechanisms involved, clarifying the performance of concrete at high altitudes. Furthermore, the validity of research methodologies reported in the literature is discussed, highlighting errors caused by variations in air pressures and the use of inappropriate test methods. Finally, various research outcomes are summarized, and the future research directions are suggested. The review indicates that the surface layer of concrete structures is the most severely affected, exhibiting numerous quality issues at early ages. The mechanism of superficial cracking should be re-evaluated based on an overall isotropy model that accounts for localized anisotropy. Additionally, vacuum saturation tests conducted at different altitudes lead to varying degrees of water absorption, introducing significant errors in the test results for concrete impermeability.</p>