title: Association of the auscultatory gap with vascular disease in hypertensive patients.
abstract: OBJECTIVE
  To assess the relation of the auscultatory gap during blood pressure measurement to cardiovascular structure and function.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A hypertension center in a university hospital.
  
  
  METHODS
  168 persons with hypertension who were otherwise healthy and were not receiving medication.
  
  
  METHODS
  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.
authors.affiliation: New York Hospital-Cornell Medical Center, New York, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Cavallini
authors.forename: M J
authors.initials: MJ
authors.lastname: Roman
authors.forename: S G
authors.initials: SG
authors.lastname: Blank
authors.forename: R
authors.initials: R
authors.lastname: Pini
authors.forename: T G
authors.initials: TG
authors.lastname: Pickering
authors.forename: R B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000503:physiopathology; D001161:Arteriosclerosis / Q000209:etiology*; D001795:Blood Pressure Determination; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000209:etiology*; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012737:Sex Factors; D016277:Ventricular Function, Left