Auscultatory gap

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An auscultatory gap is the interval of pressure where Korotkoff sounds indicating true systolic pressure fade away and reappear at a lower pressure point during the manual measurement of blood pressure. The improper interpretation of this gap may lead to blood pressure monitoring errors: namely, the falsely low recording of systolic blood pressure.

The auscultatory gap can be mistaken for the silence that occurs when the cuff pressure exceeds the systolic pressure. In this setting, the true systolic pressure can be elucidated by palpating the radial artery pulse. It is therefore recommended to palpate and auscultate when manually recording a patient's blood pressure.

There is 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.^[1]