In EUROPA, 12218 patients were randomized to the ACE inhibitor perindopril or placebo.18 Although just 27% of patients were classified as hypertensive, the definition of hypertension was based on a clinic BP >160/95 mmHg or antihypertensive therapy at baseline. The mean follow-up in EUROPA was 4.2 years. Treatment with perindopril (target dose, 8 mg daily) was associated with a 20% relative risk reduction in the composite end point of cardiovascular death, MI, or cardiac arrest (P<0.003). The benefit of active treat- ment with perindopril was similar for patients with or without hypertension as the investigators defined it. The mean reduc- tion in BP in the clinic setting was 5/2 mmHg. At baseline, EUROPA patients were at lower cardiovascular risk than HOPE patients: One third were <55 years of age; fewer had diabetes mellitus (12% versus 39%); and proportionately more EUROPA patients took antiplatelet (92% versus 76%) and lipid-lowering (58% versus 29%) drugs. Patients in the Prevention of Events With Angiotensin Converting Enzyme Inhibition (PEACE) trial106 had stable CAD and normal or slightly reduced LV function and were randomized to trandolapril (target dose, 4 mg) or placebo. Median follow-up was 4.8 years. No difference between the groups was found in the incidence of the primary compos- ite end point of cardiovascular death, MI, or coronary artery revascularization. Forty-six percent of patients were hyper- tensive, and treatment with trandolapril was associated with a mean reduction in BP of 4.4/3.6 mmHg. The annualized rate of all-cause mortality in PEACE was only 1.6%, a rate similar to that of an age- and sex-matched cohort without IHD. There was a relatively high use of revascularization before random- ization in the PEACE trial, which may have contributed to the low event rate. 