Nevertheless, the general recommendation at present is to avoid the use of aliskiren in combination with another renin-angiotensin blocking agents in patients with hypertension for the pri- mary prevention of CVD. 3. BP Goals 3.1. Epidemiology and Coronary Physiology The overall goal of therapy is to reduce excess morbidity and unnecessary deaths. In the case of hypertension, dys- lipidemia, and diabetes mellitus, surrogate end points (BP, cholesterol, and blood glucose) have been established as diagnostic markers, and discrete values of these mark- ers have been established as therapeutic targets. A com- monly cited target for BP is <140/90 mmHg in general and <130/80 mmHg in some individuals with diabetes mellitus The first AHA scientific statement on the treat- ment of hypertension in the prevention and management of IHD also recommended a goal of <130/80 mmHg in individ- uals with established CAD, with CAD equivalents, or with a Framingham Risk Score of 10%.1 Some recent meta-analyses have suggested that the lower BP target for higher-risk patients is not supported by evi- dence from high-quality, randomized, clinical trials.120-122 Whether the lower BP goal is appropriate for the preven- tion of coronary disease and for the treatment of established coronary disease is the subject of intense debate. There is a historical trend for lower BP goals, especially in those with target-organ damage. Controversy remains, however, about specific BP treatment goals for individuals with nascent or overt CAD. On the one hand, it can be argued from patho- physiological principles that very low SBP values (ie, <120 mmHg) may be appropriate to reduce myocardial work- At the same time, there is a concern that excessive lowering of DBP may impair coronary perfusion. 