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Association of the auscultatory gap with vascular disease in hypertensive patients
M C Cavallini1, M J Roman, S G Blank
1New York Hospital-Cornell Medical Center, New York, USA.
Insights
Auscultatory gaps in hypertensive patients are linked to carotid atherosclerosis and arterial stiffness, independent of age. These findings suggest potential prognostic relevance for auscultatory gaps in managing hypertension.
Area of Science:
- Cardiology
- Vascular Medicine
- Hypertension Research
Background:
- Auscultatory gap is a phenomenon during blood pressure measurement.
- Its association with cardiovascular structure and function requires elucidation.
Purpose of the Study:
- To investigate the relationship between auscultatory gaps and cardiovascular parameters.
- To determine if auscultatory gaps are associated with arterial stiffness and atherosclerosis.
Main Methods:
- Cross-sectional study of 168 hypertensive patients without medication.
- Utilized wideband external pulse recordings, ultrasonography, and applanation tonometry.
- Assessed left ventricular structure, carotid arteries, and vascular stiffness.
Main Results:
- Auscultatory gaps found in 21% of patients.
- Associated with older age, female sex, and increased arterial stiffness.
- Higher prevalence of atherosclerotic plaques (50% vs. 22%) in patients with gaps.
- Independent predictors: female sex, arterial stiffness, and atherosclerotic plaque.
Conclusions:
- Auscultatory gaps correlate with carotid atherosclerosis and arterial stiffness in hypertensive individuals.
- These associations are independent of patient age.
- Auscultatory gaps may hold prognostic value, warranting prospective confirmation.
Objective:
To assess the relation of the auscultatory gap during blood pressure measurement to cardiovascular structure and function.
Design:
Cross-sectional study.
Setting:
A hypertension center in a university hospital.
Patients:
168 persons with hypertension who were otherwise healthy and were not receiving medication.
Measurements:
Wideband external pulse recordings and ultrasonographic examination of the left ventricle and extracranial carotid arteries. Vascular stiffness was evaluated using simultaneous carotid pressure waveforms obtained by applanation tonometry of the contralateral carotid artery.
Results:
Classic auscultatory gaps were present in 21% of patients and were associated with older age (mean age SD, 64 11 years for patients with gaps and 55 13 years for patients without gaps; P < 0.001), female sex (67% of patients with gaps and 44% of patients without gaps were female; P < 0.05), and increased arterial stiffness (arterial stiffness index, 8.5 4.6 in patients with gaps and 5.8 3.2 in patients without gaps; P < 0.005). The prevalence of atherosclerotic plaques was increased more than twofold among patients with gaps compared with patients without gaps (50% compared with 22%; p < 0.002). Patients with and without auscultatory gaps had similar blood pressures, left ventricular structure and function, serum cholesterol levels, and smoking history. Logistic regression analysis indicated that only female sex (P < 0.02), arterial stiffness (P < 0.002), and atherosclerotic plaque (P < 0.02) were independently associated with the presence of an auscultatory gap.
Conclusions:
This study provides strong evidence that auscultatory gaps are related to carotid atherosclerosis and to increased arterial stiffness in hypertensive patients, independent of age. Although these observations need to be confirmed prospectively, they suggest that auscultatory gaps may have prognostic relevance.
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