Recognizing malingering hypertension in young adults
Bibliographic record
Abstract
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). CONCLUSION: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".