Nitrates should be avoided in patients with suspected right ventricular infarc- tion and in those with hemodynamic instability. Sublingual or intravenous nitroglycerin is pre- ferred for initial therapy and can be transitioned later to a longer-acting preparation if indicated. 3. If there is a contraindication to the use of a -blocker or intolerable side effects, then a nondihydropyridine CCB such as verapamil or diltiazem may be substi- tuted for patients with ongoing ischemia, provided that LV dysfunction or HF is not present. If the an- gina or hypertension is not controlled on a -blocker alone, a longer-acting dihydropyridine CCB may be added after optimal use of an ACE inhibitor (Class IIa; Level of Evidence B). 4. An ACE inhibitor (Class I; Level of Evidence A) or an ARB (Class I; Level of Evidence B) should be added if the patient has an anterior MI, if hypertension per- sists, if the patient has evidence of LV dysfunction or HF, or if the patient has diabetes mellitus. For lower- risk ACS patients with preserved LV ejection frac- tion and no diabetes mellitus, ACE inhibitors can be considered a first-line agent for BP control (Class IIa; Level of Evidence A). 5. Aldosterone antagonists are indicated for patients who are already receiving -blockers and ACE inhibitors after MI and have LV dysfunction and either HF or diabetes mellitus. Serum potassium levels must be monitored. These agents should be avoided in patients with elevated serum creatinine levels ( 2.5 mg/dL in men, 2.0 mg/dL in women) or elevated potassium levels ( 5.0 mEq/L) (Class I; Level of Evidence A). 6. Loop diuretics are preferred over thiazide and thiazide-type diuretics for patients with ACS who have HF (NYHA class III or IV) or for patients with CKD and an estimated glomerular filtration rate <30 mL/min. 