As a DM, 4e is all about loving the slow burn.
Usually, the stress point in a 4e fight comes from a series of events, rather than a single die roll. It might end with one die roll, but you get there via a sequence of attacks and rolls.
Ghouls are my absolute favorite monster type right now. I've painted up a bunch of metal ones, and I've been noodling with some new variations on them. They epitomize the slow burn in action.
When a ghoul hits a PC, he's immobilized and vulnerable to the ghoul's bite. The tension for the player comes from his save. He also gets to attack, giving him the chance to do something to hinder the ghoul or maybe kill it before its next turn. On the ghoul's next turn, if the PC blew his save there's a nasty attack incoming. That attack still has to hit, and if it does the PC's next save might be, in essence, a save versus dropping to 0 on the ghoul's next turn.
IME, that ebb and flow is where the fear of monsters comes into play. Even if the ghoul misses, it has enough hit points that the players know its going to get in a few shots before they can take it out. You have more chances to enter that "tension loop." On top of that, since you can have several ghouls in a fight, you have even more chances to send a PC down the short road to ghoul chow-dom.
So, you have a lot of tension, but it builds up over time rather than resolving on one roll.