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Atherosclerosis masks Hill's sign in severe chronic aortic regurgitation

Journal of Human Hypertension volume 22, pages 868–870 (2008)Cite this article

Increased systolic blood pressure gradient (SBPG) between the lower and upper extremities is a sign of severe chronic aortic regurgitation (AR). Among 23 patients (58±19 years) with severe AR⩾3 months, we prospectively found the SBPG (BP difference between the lower and ipsilateral upper extremities) to be inversely related to maximal aortic intimal-medial thickness measured on transesophageal echocardiography and to coronary disease. In severe chronic AR, SBPG is decreased in the presence of coronary artery disease (CAD) and more marked aortic atherosclerosis.

Increased systolic blood pressure gradient between the lower and upper extremities has long been considered a sign of severe chronic AR. This finding, known as Hill's Sign, was found correlated with AR severity.1 Although the exact mechanism is unknown, Hill's Sign is felt to be related to the enhanced arterial pressure wave transmission and reflection. However, the significance of this finding has been questioned.2, 3 We hypothesized SBPG to be influenced by left ventricular (LV) function and aortic properties.

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  1. Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA

    J M Lazar, G Qureshi & L Salciccioli

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  1. J M Lazar
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  2. G Qureshi
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  3. L Salciccioli
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Correspondence to J M Lazar.

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Lazar, J., Qureshi, G. & Salciccioli, L. Atherosclerosis masks Hill's sign in severe chronic aortic regurgitation. J Hum Hypertens 22, 868–870 (2008). https://doi.org/10.1038/jhh.2008.60

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