Recognizing malingering hypertension in young adults.
OBJECTIVE
Hypertension is unusual in young adults. Malingering hypertension is clinically suspected when there is a potential external secondary gain, absence of patient cooperation during diagnostic evaluation and a lack of response to antihypertensive treatment. The aim of this study was to investigate the possibility that abnormal ambulatory blood pressure patterns may be indicative of malingering hypertension rather than hypertension itself.


METHODS
Young adults aged 19-20 years, referred for evaluation of high ambulatory blood pressure, underwent a detailed clinical interview, physical examination, and both in-clinic and 24-h ambulatory blood pressure monitoring. Blood pressure patterns were compared in patients with normal blood pressure values, essential hypertension, or suspected malingering hypertension (20 in each group).


RESULTS
Both the suspected malingering hypertension and the essential hypertension group had higher blood pressure values during day and night than the normotensive group. Compared with essential hypertension subjects, the malingering hypertension group showed a greater fluctuation of blood pressure values, lower total percentage of time of abnormally high systolic blood pressure values during the day (41.9+/-16 vs. 65.9+/-12.4, P<0.001) and night (41.8+/-25 vs. 69+/-22.4, P=0.001), and higher maximum heart rate values during the day (132.8+/-15.2 vs. 115.1+/-11.6, P<0.001) and night (93.4+/-19.2 vs. 80.5+/-13.2, P=0.028).


CONCLUSIONS
Patients with malingering hypertension form a distinct clinical group. We suggest that the diagnostician rely on clinical suspicion, fulfillment of our proposed criteria, and distinguishable characteristics of blood pressure patterns. Successful recognition of malingering hypertension can spare patients from unnecessary medical and surgical treatments.
Nussinovitch
Naomi
N
Hypertension Unit, Department of Internal Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel. nussim@clalit.org.il
Peleg
Edna
E
Nussinovitch
Moshe
M
Nussinovitch
Udi
U
D018660:Blood Pressure Monitoring, Ambulatory; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008297:Male; D008306:Malingering / Q000175:diagnosis*; D010349:Patient Compliance; D055815:Young Adult