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Association of the Auscultatory Gap with Vascular Disease in Hypertensive Patients

M. Chiara Cavallini, MD; Mary J. Roman, MD; Seymour G. Blank, PhD; Riccardo Pini, MD; Thomas G. Pickering, MD, PhD; and Richard B. Devereux, MD
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From The New York Hospital-Cornell Medical Center, New York, New York, and University of Firenze, Firenze, Italy. Acknowledgments: The authors thank Mariane Spitzer, RDMS, for invaluable technical assistance and Virginia Burns for assistance in manuscript preparation. Grant Support: In part by grants HL 18323 and HL 47540 from the National Heart, Lung, and Blood Institute; a grant from the Michael Wolk Heart Foundation; and a research grant from the University of Firenze (to Dr. Cavallini). Requests for Reprints: Mary J. Roman, MD, Division of Cardiology, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, NY, 10021. Current Author Addresses: Drs. Cavallini and Pini: Universita degli Studi di Firenze, Istituto di Gerontologia e Geriatrica, Via delle Oblate, 4, 50141 Firenze, Italy.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(10):877-883. doi:10.7326/0003-4819-124-10-199605150-00003
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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.


Grahic Jump Location
Figure 1.
Recording of classic auscultatory gap (G3).[6]

This auscultatory gap (auscultatory marker) occurs during deflation of the cuff pressure to between the systolic and diastolic pressures (Finapres recording). The G3 gap is characterized by the disappearance of Korotkoff sounds (K sound), persistence of activity on the wideband external pulse recording (FES), and the absence of phasic fluctuation in arterial pressure ECG equals electrocardiogram; FES equals foil electret sensor. Reproduced with permission from the American Heart Association .

Grahic Jump Location




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