The -blockers carvedilol, metoprolol, and bisoprolol have been shown to improve outcomes in patients with HF.1 2.1.3. ACE Inhibitors TheACE inhibitors are effective in reducing initial IHD events and are recommended for consideration in all patients after MI. They are proven to prevent and improve both HF101,102 and the progression of CKD.103 When combined with thiazide diuretics, ACE inhibitors reduce the incidence of recurrent Major trials have addressed the use of ACE inhibi- tors in patients with IHD but without HF or known significant LV systolic impairment. In the HOPE study,16 9297 high-risk patients, of whom 80% had a history of CAD, were assigned to receive either Rosendorff et al Treatment of Hypertension in Patients With CAD 1381 ramipril (10 mg once nightly) or placebo and followed up for a mean of 5.0 years. Treatment with ramipril was associ- ated with a 22% reduction in the composite end point of car- diovascular death, MI, and stroke (P<0.001) and comparably significant reductions in each of the individual components. There were also significant reductions in the rates of revascu- larization, cardiac arrest, HF, worsening angina, and all-cause mortality with ramipril therapy. The mean reduction in the clinic BP with active treatment was 3/2 mmHg. These car- diovascular benefits were initially thought to be independent of BP, but an interesting but very small HOPE substudy105 revealed a more marked reduction in 24-hour ambulatory BP with ramipril not observed in the main trial, which reported only the clinic BPs. 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. 