altitude does not matter
however, you must know the HORIZONTAL distance between you and the target.
For instance, if you were on a building roof that was 300 yards tall and used your range finder to find a guy who was standing on the ground was 500 yards away you'd have two of three sides of a triangle.
Distance to target would be the hypotenuse, and the height would be the height of the building in yards. However, on a flat surface you'd adjust your rifle for 500 yards. Because you are elevated, you'd have to solve to find the 'base' distance to adjust your rifle to.
Thanks to A Squared + B Squared = C Squared you can solve it and find the base is 400 yards.
Off of a 200 yard zero using a 308, a 500 yard horizontal shot would cause the bullet to drop 52 inches off of POA, so you'd aim 52 inches high. However, as 400 yards is the REAL horizontal distance, and 400 yards is only 23 inchs off of POA from a 200 yard zero, you'd shoot about two feet over the head of your target.