There was no difference between the groups in the composite end point of death, MI, or stroke over a mean follow-up of 2.7 years. More than 50% of patients in ALLHAT had a history or signs of atherosclerotic vascular disease, and there was no significant difference in the inci- dence of coronary end points among patients allocated a thiazide-type diuretic, a long-acting dihydropyridine CCB, or an ACE inhibitor.96 CAMELOT compared amlodipine or enalapril with placebo in normotensive patients with CAD, 60% of whom had a history of hypertension.150 Although the BP reduction was similar in the 2 active treatment groups, adverse cardiovascular events occurred less frequently in the amlodipine group than in the enalapril group. An intravascu- lar ultrasound substudy of CAMELOT showed progression of atherosclerosis in the placebo group (P<0.001), a trend toward progression in the enalapril group (P=0.08), and no progression in the amlodipine group (P=0.31). Amlodipine may have pleiotropic effects beyond BP lowering that favor atherosclerotic plaque stabilization.172,173 The VALUE trial randomized 15245 hypertensive patients at high risk of cardiac events to valsartan or amlodipine.107 Forty-six percent of patients in both groups had CAD. Mean follow-up was 4.2 years. No difference between groups was observed in the primary composite end point of cardiac mor- bidity and mortality. The risk of MI was lower in the amlodip- ine group, whereas the risk of new-onset diabetes mellitus was lower in the valsartan group. Of note, amlodipine was signifi- cantly more effective in reducing BP, especially over the first year of the trial. 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. 