PROGNOSTIC VALUE OF AMBULATORY MEASUREMENT OF THE TIMING OF KOROTKOFFSOUNDS IN ELDERLY HYPERTENSIVES - A PILOT-STUDY

Alteration in the physical properties of the large arteries is probabl y an important contributory factor in morbidity and mortality in the e lderly as well as in patients with hypertension or diabetes. We have d eveloped a simple method based on the ambulatory measurement of the ti ming of Korotkoff sounds (QKD interval), together with blood pressure, to assess these properties. We report its prognostic value in a retro spective survey of elderly hypertensives. We included in this study 13 4 hypertensive patients over 45 years of age with no cardiovascular co mplications, either receiving placebo or prior to treatment with antih ypertensive medication and seen between January 1992 and July 1993. In June 1995, a survey was carried out to determine outcome by contactin g the patients themselves and their family physicians. Data on outcome were obtained for 111 patients with a mean follow-up period of 30 +/- 8 months. At least one cardiovascular complication was recorded durin g the follow-up period in 14 patients. From the Cox model, data obtain ed from QKD monitoring, namely the QKD(100-60), was the best predictor of complications and remained significant (P < .01) even after introd uction of age, mean 24 h SEP, gender, and smoking into the model. A QK D(100-60) below 187 msec was accompanied by a relative hazard of cardi ovascular complications adjusted for age and mean 24 h BP of 7.3 (95% confidence interval: 2.9 to 11.7). The indices provided by the ambulat ory measurement of QKD interval are significant predictors of cardiova scular complications independently of age and BP. This new method seem s to add useful information to classic ambulatory blood pressure monit oring. However this will require confirmation in a large prospective s tudy. (C) 1997 American Journal of Hypertension, Ltd.