Can we predict the presence of coronary lesions from blood pressure measurement? A new clinical method

Abstract

The roles of arterial function and structure in cardiovascular physiology have expanded with the development of a variety of parameters that evaluate arterial stiffness. Markers of arterial stiffness have been correlated with cardiovascular outcomes. We aimed to find a simple, clinical, noninvasive method to predict atherosclerosis that leads to the development of coronary artery disease (CAD). We aimed to find a simple, clinical, noninvasive method to predict atherosclerosis that leads to the development of CAD. We included 100 cases that underwent coronary angiography in our center owing to different indications. The blood pressure in all cases was measured by two different observers. The oscillatory systolic blood pressure (OSBP) was defined as the point at which the mercury began to oscillate to a minimum level of 1 mm Hg. The auscultatory systolic blood pressure (AUSBP) was defined as the first Korotkoff sound. The difference between OSBP and AUSBP was calculated and called the oscillatory gap (OG). The correlation between the OG and the presence of coronary lesion in coronary angiography was statistically calculated. The study populations had a mean age of 57.3±9 years. The mean±s.d. OG was 14.44±10.44. There was a highly significantly positive correlation between the OG and the presence of coronary artery lesions (r=0.399 and P-value <0.000). There was also a significantly positive correlation between the presence of hypertension and the OG (r=0.376 and P-value <0.000). The difference between OSBP and AUSBP could be used as a simple method to detect atherosclerotic arterial changes. This method could indicate the degree of arterial stiffness. There was a significantly positive correlation between this new indicator of arterial stiffness and the presence of CAD. Any patient with a wide gap between OSBP and AUSBP should be treated early with antihypertensive drugs and statins before the development of CAD.

The Relation between the New Clinical Parameter “Oscillatory Gap” and Carotid Intima Media Thickness as a Marker for Atherosclerosis

“…This is consistent with the fi nding of our previous study which shows the presence of a highly positive correlation between Tahlawi gap and hypertension [7].…”

“…These oscillations are refl ected to the mercury in the sphygmomanometer earlier than the sound that is auscultated. This difference generates the Tahlawi gap [7].…”

“…Auscultatory systolic blood pressure (AUSBP) was defi ned as the fi rst KorotKoff sound. The difference between OSBP and AUSBP was calculated and called the 'OG' or (Tahlawi gap) (Figure 1) [7].…”

“…Hence, this gap could predict cardiovascular atherosclerotic diseases, regardless of the presence of hypertension [7].…”

Systolic peak foot-to-apex time interval, a novel oscillometric technique for systolic blood pressure measurement

“…Also using a mathematical model, Liu et al [7] demonstrated that calculating SBP and DBP from the oscillometric envelope with fixed ratios measurement produces errors that increase when the arterial wall stiffens and/or the PP increases. Differences between oscillometric and auscultatory BP measurements are indeed greater in study participants with increased arterial wall stiffness [16], and have been proposed as an indicator of arterial stiffness, predictive of coronary lesions [33]. It is therefore all the more interesting that our technique yielded its best correlation with Korotkoff sounds in older study participants and in study participants with cardiovascular risk factors.…”