Additional insights into the value of ARBs are provided by the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity In patients not receiving ACE inhib- itors because of previous intolerance, the use of candesartan was associated with a significant reduction in the primary composite end point of cardiovascular death and hospital read- mission for HF compared with placebo.259 In the combination arm of VALIANT, valsartan and captopril together showed no increased effect over captopril alone and had a higher inci- dence of discontinuation because of adverse effects.91 These results differed from those of the CHARM-Added trial, in which patients with stable LV dysfunction benefited from the combination of an ACE inhibitor and the ARB candesartan.263 The lack of superiority of the combination treatment in the VALIANT trial was likely attributable to the fact that the ACE inhibitors and ARBs were titrated aggressively at the same time in the early post-MI period, which resulted in more side effects. In stable HF patients undergoing an established ACE inhibitor therapy, the CHARM trial showed that the addition of an ARB was well tolerated and beneficial. This is a strategy that could be used to control BP if needed. -Blockers lower BP and are negatively inotropic and chro- notropic. They therefore alleviate ischemia and angina, in addition to lowering BP. The role of -blockers in the management of patients with HF is well established. The Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF) randomized patients with NYHA class II to IV HF symptoms to receive metoprolol succinate ver- This trial was stopped prematurely because of a 34% reduction in mortality in the metoprolol arm. 