There was also a strong trend for an excess risk of stroke in the valsartan group, likely resulting from this same BP differential that favored amlodipine. The investiga- tors highlighted the need for aggressive BP control in high-risk hypertensive patients, a goal that frequently requires combina- tion therapy at the outset, a concept supported by the Blood Pressure Lowering Treatment Trialists Collaboration.174 4.1.3. ACE Inhibitors ACE inhibitors should be prescribed to all CAD patients with stable angina who also have hypertension, diabetes mellitus, an LV ejection fraction 40%, or CKD unless contraindicated (Class I; Level of Evidence A).169 The clinical trials that sup- port the use of ACE inhibitors in the management of patients with stable CAD were described in the Antihypertensive Drugs for the Secondary Prevention of Cardiovascular Events in Patients With CAD section. They are the HOPE study,16 in which high-risk individuals, 80% of whom had CAD, were given an ACE inhibitor (ramipril 10 mg/d), with a reduction in CVD end points by 20% to 25%; EUROPA,18 which showed a 20% relative risk reduction in the primary end point, a com- posite of cardiovascular death, MI, or cardiac arrest in patients in subjects with established CAD treated with perindopril 8 mg/d versus placebo; and SAVE.17 On the other hand, there have been negative studies. These in which patients with stable CAD and normal or slightly reduced LV function were randomized to trandolapril (target dose, 4 mg) or placebo. No difference between the groups was found in the incidence of the primary composite end point of cardiovascular death, MI, or coronary revascularization. Patients in the PEACE trial were at lower risk and were receiving more aggressive secondary prevention therapy than those in the HOPE trial. 