In the absence of prior MI or LV dysfunction, anti- hypertensive therapies other than -blockers should be considered for chronic hypertension manage- ment long term after CABG (Class IIb; Level of Evidence B). 6. Routine ACE inhibitor therapy is not recommended early after CABG among patients who do not have a history of recent MI, LV dysfunction, diabetes mellitus, or chronic kidney disease because it may lead to more harm than benefit and an unpredictable BP response (Class III; Level of Evidence B). Previous MI and LV Dysfunction Surgical revascularization is commonly performed for patients with reduced ejection fraction (EF) <40%.236 The most com- mon cause of reduced EF is previous MI, although other abnormalities such as valvular heart disease and hypertension are also recognized causes. Some patients have post-MI stun- ning or myocardial hibernation attributable to chronic isch- emia from severe CAD. Although many have improvement or recovery in their cardiac function after surgical revasculariza- tion, others have persistent heart failure and LV dysfunction The current discussion focuses on the appli- cation of secondary prevention therapies, including medical and device therapy after CABG, for patients with persistently reduced EF despite revascularization. -Blocker Therapy Elevated plasma catecholamine levels and direct sympathetic activity have deleterious effects on the heart by causing tachy- cardia, vasoconstriction, increased contractility, and ventricu- -Blockers blunt these effects and impede the maladaptive ventricular remodeling from chronic sympa- thetic activation. As described above, in addition to preventing heart failure, -blockers prevent recurrent ischemia and AF, a common postoperative condition. Most patients with persistently reduced EF after CABG are likely to have had a prior MI, and in this patient popula- tion, evidence supports the use of -blockers on top of back- ground therapy with ACE inhibitors, even in the absence of heart failure. 