Prognostic value of ambulatory measurement of the timing of Korotkoff sounds in elderly hypertensives: a pilot study.

Alteration in the physical properties of the large arteries is probably an important contributory factor in morbidity and mortality in the elderly as well as in patients with hypertension or diabetes. We have developed a simple method based on the ambulatory measurement of the timing of Korotkoff sounds (QKD interval), together with blood pressure, to assess these properties. We report its prognostic value in a retrospective survey of elderly hypertensives. We included in this study 134 hypertensive patients over 45 years of age with no cardiovascular complications, either receiving placebo or prior to treatment with antihypertensive medication and seen between January 1992 and July 1993. In June 1995, a survey was carried out to determine outcome by contacting 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 during the follow-up period in 14 patients. From the Cox model, data obtained from QKD monitoring, namely the QKD(100-60), was the best predictor of complications and remained significant (P < .01) even after introduction of age, mean 24 h SBP, gender, and smoking into the model. A QKD(100-60) below 187 msec was accompanied by a relative hazard of cardiovascular 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 ambulatory measurement of QKD interval are significant predictors of cardiovascular complications independently of age and BP. This new method seems to add useful information to classic ambulatory blood pressure monitoring. However this will require confirmation in a large prospective study.