901-80 Auscultatory Gaps and Target Organ Damage in Hypertensive Patients

• Published in: Journal of the American College of Cardiology 1995-02, Vol.25 (2), p.24A-24A
• Main Authors: Chiara Cavallini, M., Roman, Mary J., Blank, Seymour G., Pini, Riccardo, Pickering, Thomas G., Devereux, Richard B.
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)91557-E

Auscultatory gaps are a common finding in clinical practice but their clinical and prognostic importance has never been assessed. To examine the relation of auscultatory gaps to left ventricular and arterial structure and function, wideband external pulse recordings during cuff deflation to detect auscultatory gaps and ultrasonographic examination of left ventricle and extracranial carotid artery were performed in 168 unmedicated, asymptomatic hypertensive subjects. Vascular stiffness was also evaluated by simultaneous carotid pressure waveforms obtained by applanation tonometry of the contralateral carotid artery. Auscultatory gaps were present in 21% of the population and were associated with older age (64±11 vs 55±13 years, p<0.0005). female gender (66 vs 44%, p<0.05) and increased arterial stiffness (beta = 8.5±4.6 vs 5.8±3.2, P<0.005). Differences in arterial stiffness persisted after controlling for the confounding effects of age and gender. The prevalence of atherosclerotic plaques was more than two-fold increased among subjects with gaps (50 vs 22%, p<0.005). No significant differences were found in left ventricular structure and function between the subjects with and without gaps. The two populations had similar systolic and diastolic blood pressures, serum lipid levels and smoking history. Logistic regression analysis including age in the model indicated that only female gender, beta (an index of arterial stiffness) and the presence of plaque were independently related to the presence of auscultatory gaps. This study provides the first evidence that auscultatory gaps are related to the presence of carotid atherosclerosis and to increased arterial stiffness in hypertensive patients, independently of age. Although these observations need to be confirmed by prospective studies they suggest a prognostic relevance of the auscultatory gaps.