ARBs are often considered to be an alternative therapy in individu- als with cardiovascular disease who are intolerant of ACE inhibitors. In the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) study, protection against a composite of cardiovascular events that included MI and HF was similar to that observed for the CCB amlodipine.107 However, there were important differences in BP control in the early stages of the VALUE trial (a significant BP difference in favor of amlodipine) that may have confounded outcomes for MI and Beneficial cardiovascular outcomes were not shown in the Optimal Trial in Myocardial Infarction With the Angiotensin II Antagonist Losartan (OPTIMAAL).109 The lack of ben- efit may have been attributable to inadequate doses of losar- tan. In the Valsartan in Acute Myocardial Infarction Trial (VALIANT), the ARB valsartan had effects similar to those of the ACE inhibitor captopril in reducing cardiovascular event The combination of theARB with theACE inhib- itor yielded an increase in adverse events with no incremental benefit for cardiovascular events. In the Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease 5296 high-risk patients, of whom 75% had CAD, were randomized to telmisartan (80 mg daily) or placebo for a median duration of 4.7 years. The mean BP in the telmisartan group was 4.0/2.2 mmHg lower than that in patients randomized to placebo. The primary outcome of cardiovascular death, nonfatal MI, nonfatal stroke, and hospi- talization for HF occurred in 15.7% of the telmisartan group and 17.0% of the placebo group (P=0.216). The composite of cardiovascular death, nonfatal MI, and stroke occurred in 13% of patients on telmisartan versus 14.8% of the placebo group (P=0.048), and fewer patients in the telmisartan group had a cardiovascular hospitalization (30.3% versus 33%; P=0.025). The tolerability of telmisartan was similar to that of placebo. 