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International Journal of Rheumatology
Volume 2012, Article ID 590845, 4 pages
http://dx.doi.org/10.1155/2012/590845
Research Article

The Prevalence and Clinical Correlates of an Auscultatory Gap in Systemic Sclerosis Patients

1Division of Rheumatology, Department of Internal Medicine, University of Utah, 4B200 SOM, 30 North 1900 East, Salt Lake City, UT 84132, USA
2Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA
3Department of Medicine, Salt Lake City Veterans Affairs Medical Center and the University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA

Received 11 October 2011; Accepted 4 December 2011

Academic Editor: Bruce M. Rothschild

Copyright © 2012 Tracy M. Frech et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Accurate blood pressure (BP) measurement is essential to the diagnosis and management of hypertension in patients with systemic sclerosis (SSc) to help prevent renal and cardiovascular complications. The presence of an auscultatory gap during manual BP measurement—the temporary disappearance of the Korotkoff sounds during cuff deflation—leads to a potentially important underestimate of systolic BP if undetected. Objectives. Since the presence of an auscultatory gap is frequently associated with increased vascular stiffness, we investigated its presence and correlates in 50 consecutive SSc patients. Methods. For each patient, BP was measured sequentially using three different approaches performed in the same order. Results. Sixteen of 50 patients (32%) had an auscultatory gap which if undetected would have resulted in clinically important underestimates of systolic BP in 4 patients. The presence of an auscultatory gap was statistically associated with the presence of antibodies to RNA polymerase III ( 𝑃 < 0 . 0 0 6 8 ) and SSc diagnosis type ( 𝑃 < 0 . 0 1 ). Conclusions. Our study demonstrates that auscultatory gaps are relatively common in SSc and correlate with markers for SSc vasculopathy. If undetected auscultatory gaps may result in clinically important underestimation of BP. Thus, electronic oscillometric BP may be preferred in SSc patients.