Results/Conclusions: The literature review revealed that livestock farming and ranching, water use and flow modifications, mining and climate extremes were the four main threats affecting the integrity of high altitude wetlands. Of the 2,245 RAMSAR sites covering 2,149,907 km2 over the world 35 (1.5%), covering 50,842 km2 (2.3%) laid completely over 3000 m. A comparison of Ramsar protection criteria between high altitude and low altitude wetlands (< 3000 m) revealed interesting attributes of the former in terms of ecosystem sentinel potential. High altitude wetlands were recognised as being unique ecosystems, sheltering endangered species and supporting the population of important plant and animal species (in particular birds populations) at significantly higher frequency than their lowland counterparts. There results argue in favour of the use of high altitude wetlands as ecosystem sentinel of global change. Based on both literature survey and analyses, we propose a general conceptual framework for a sustainable management and conservation of biodiversity and ecosystem services of high altitude wetlands in the face of global changes. This framework builds upon the classical drivers–pressures–state–impact–response model that links scientific findings with real world issues, thereby favouring science-based resource management decisions.