THE AUSCULTATORY FINDINGS IN HYPERTENSION

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Abstract
A clinical and phonocardiographic study was performed in 100 consecutive hypertensive patients with average casual blood pressure readings exceeding 180/100 mm Hg. An atrial sound was present in at least 50% and probably about 70% of the series. Spontaneous variations in the timing of the atrial sound made it impossible to give an accurate assessment of its incidence. The difficulty in differentiating between a "late" atrial sound and a "split" first heart sound is discussed. The atrial sound was palpable in 38 patients, in only one of whom was it not audible also. A 3d heart sound was present in 34 patients. Provided the patient was in sinus rhythm and the P-R interval not unduly short, it was our experience that the atrial sound invariably developed before the 3d heart sound. Hypertensive patients under the age of 40 might have a physiological 3d sound. An ejection systolic murmur was present in 71 patients. Seven of these died and the aortic valves were normal at necropsy in 6. A regurgitant systolic murmur was present in only 2 patients. In a total of about 400 patients we heard apical regurgitant systolic murmurs in 9, 8 of whom were suspected or shown to have organic mitral regurgitation. Functional mitral regurgitation was considered the cause of the systolic murmur in only one instance. A functional mid-diastolic apical murmur was encountered in only 3 instances in observations on approximately 400 patients. Excluding rheumatic valvular disease, the commonest cause of murmurs originating at the mitral valve in hypertension was atherosclerosis and calcification of the posterior mitral cusp. Nine cases had an aortic early diastolic murmur. Three of these died and had normal aortic valves at autopsy. The onset of the major components of the 1st heart sound was delayed in the 50 hypertensive patients in whom this measurement was made on phonocardiograms and compared with 25 normal controls. On clinical assessment the aortic component of the second sound was thought to be louder than normal in 81% of this series.