Because of their inhibitory activity on the ubiq- uitous COXs, NSAIDs have an extensive adverse side effect profile, particularly renal and gastrointestinal. The increased cardiovascular hazards associated with NSAIDs have been observed in several studies of patients without ACS.234,235,237,238 The PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen Or Naproxen) trial, in progress at the time of publication, is the first study of patients with high cardiovascular risk who are receiving long- term treatment with a selective COX-2 inhibitor or traditional NSAIDs. PRECISION will examine the relative cardiovas- cular safety profiles of celecoxib, ibuprofen, and naproxen in patients without ACS.239 See Online Data Supplement 10 for additional information on analgesic therapy. 4.1.2.3. Beta-Adrenergic Blockers: Recommendations Class I 1. Oral beta-blocker therapy should be initiated with- in the first 24 hours in patients who do not have any of the following: 1) signs of HF, 2) evidence of low-output state, 3) increased risk for cardiogenic shock, or 4) other contraindications to beta block- ade (eg, PR interval >0.24 second, second- or third- degree heart block without a cardiac pacemaker, active asthma, or reactive airway disease).240 242 (Level of Evidence: A) 2. In patients with concomitant NSTE-ACS, stabilized HF, and reduced systolic function, it is recommended to continue beta-blocker therapy with 1 of the 3 drugs proven to reduce mortality in patients with HF: sus- tained-release metoprolol succinate, carvedilol, or bi- soprolol. (Level of Evidence: C) 3. Patients with documented contraindications to beta blockers in the first 24 hours of NSTE-ACS should be re-evaluated to determine their subsequent eligibility. (Level of Evidence: C) Class IIa 1. It is reasonable to continue beta-blocker therapy in patients with normal LV function with NSTE- (Level of Evidence: C) Class III: Harm 1. 