The tolerability of telmisartan was similar to that of placebo. The investigators concluded that telmisartan had modest ben- efits on the composite outcome end point of cardiovascular death, MI, and stroke and was well tolerated. 2.1.5. Aldosterone Antagonists The aldosterone antagonists spironolactone and eplerenone lower BP alone or when added to other antihypertensive agents and have a protective effects in patients with chronic and advanced HF (in the Randomized Aldactone Evaluation in patients with LV dysfunction after MI (in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study [EPHESUS]),112 and in patients with chronic HF and mild symptoms (in the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure [EMPHASIS-HF]).113 In both RALES and EMPHASIS-HF, the majority of the subjects had IHD. 2.1.6. Calcium Channel Blockers CCBs form a heterogeneous class of agents that lower BP but have differing effects on cardiac conduction and myocardial contractility. In ALLHAT, the primary prevention of cardio- vascular events with the dihydropyridine CCB amlodipine was equivalent to that produced by the diuretic chlorthalidone or the ACE inhibitor lisinopril,96 and superiority over a -blocker was claimed in Anglo-Scandinavian Cardiac Outcomes Primary protection with verapamil-based therapy was shown to be similar to that of a diuretic (hydro- chlorothiazide) or a -blocker (atenolol) in the Controlled Onset Verapamil Investigation of Cardiovascular End Points and International Verapamil-Trandolapril In the Nordic Diltiazem (NORDIL) overall cardiovascular event rates were similar for diltiazem and a combination of diuretic and -blocker. Thus, CCBs are alternatives to -blockers in the treatment of angina pectoris but are not recommended for secondary cardiac pro- tection because of the relative lack of benefit of this class in particularly compared with ACE inhibitors96 2.1.7. 