April 2006

A 62-year-old woman presented to the emergency department with chest pain.

We compared the prognosis of patients with "white-coat" hypertension (WCHT) with that of patients with "masked" hypertension (MHT). The 10-year composite risk of stroke morbidity and cardiovascular mortality for patients with WCHT was similar to the risk for patients with sustained normal blood pressure, whereas the risk was markedly increased for patients with MHT and sustained hypertension. This indicates that conventional blood pressure measurements may fail to distinguish some patients at high or low risk.

A 65-year-old man diagnosed with essential hypertension had been treated with antihypertensive medication for 2 years at his physician's office. His systolic/diastolic blood pressure in the office had been controlled at about 130/80 mm Hg with 2 antihypertensive drugs taken in the morning after breakfast. Although he does not have any cardiovascular complications, he is a smoker, is obese, and has diabetes.

We evaluated the risk and timing of sudden death among high-risk patients after myocardial infarction (MI). Among survivors of acute MI with reduced left ventricular systolic function or heart failure, or both, the risk of sudden death from cardiac causes was highest in the first 30 days after MI. These findings indicate a need for early intervention to prevent sudden death during this vulnerable period.

Anderson and Solomon (page 17) elegantly elucidate the patterns of sudden death after myocardial infarction (MI) in their analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT) database.

A number of studies have documented the incremental predictive ability of 24 hour ambulatory blood pressure (BP) monitoring over traditional office or casual BP monitoring for predicting adverse cardiovascular events.

We showed that impaired insulin sensitivity in patients with chronic heart failure (CHF) significantly predicted impaired survival. Insulin resistance relates to an advanced disease state and higher mortality independent of body composition and established prognosticators, implicating a pathophysiologic role for insulin sensitivity in CHF. Patients with CHF may possibly benefit from early treatment of impaired insulin sensitivity, but further research is needed.

The prevalence of obesity and heart failure has been increasing. A report linking the 2 found an increased risk of heart failure of 5% for men and 7% for women for each increment of 1 in body mass index (BMI).

We examined the relationship between the 6-minute walk test and self-perceived changes in symptoms in 1077 elderly patients with chronic heart failure. We found that changes in 6-minute walk test distance were sensitive to changes in self-perceived symptoms of heart failure.

In an era when high-tech procedures are becoming increasingly common in cardiology, it's refreshing to see continued interest in one of the lowest-tech diagnostic/prognostic procedures currently available: the 6-minute walk test.