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Lovibond and colleagues report that ambulatory blood-pressure monitoring is the cost-effective option for the diagnosis of hypertension. Room for refining this analysis exists, but the focus on cost-saving by avoiding unnecessary treatment is compelling and should receive due consideration by guideline writers.
Cardiac remodeling encompasses structural and functional changes of the left ventricle in response to stressors, and precedes clinical heart failure. Evaluation of cardiac remodeling can help to select patients with subclinical heart failure for early treatment. Drs Gjesdal, Blumke, and Lima review population-based studies of cardiac remodeling, describing risk factors, screening strategies, and outcome measures.
White-coat hypertension is characterized by an elevation in clinic blood pressure but normal home or ambulatory blood-pressure values, whereas patients with masked hypertension have normal clinic blood pressure and elevated ambulatory or home blood-pressure. In this article, Prof. Mancia and colleagues assess prevalence, diagnosis, and clinical management of white-coat and masked hypertension.
This Review outlines the main ethical and legal issues surrounding informed consent for the insertion, removal, and deactivation of implantable cardioverter-defibrillators (ICDs). The authors also provide an overview of current guidelines for communication with and involvement of patients and next of kin throughout the decision-making process.
Anomalous origination of a coronary artery from the opposite sinus is a congenital heart defect with an uncertain prevalence and prognosis. The authors review the current understanding of the pathophysiology of the condition, the imaging modalities available to diagnose and functionally assess patients, and the medical, interventional, and surgical treatment options.
This paper explores the rationale for early, 'vitamin-like' use of statins to lower LDL levels in asymptomatic adults aged 35–50 years. The authors describe the features of a trial designed to determine whether this approach could dramatically reduce the burden of atherosclerosis and atherothrombotic events in the general population.
