The nondihydropyridine agents diltiazem and verapamil also decrease the sinus node discharge rate and slow atrioventricu- lar nodal conduction. CCBs or long-acting nitrates should be prescribed for the relief of symptoms when -blockers are contraindicated or cause unacceptable side effects in patients with stable angina (Class IIa; Level of Evidence B).168 CCBs or long-acting nitrates in combination with -blockers should be prescribed for the relief of symptoms when initial therapy with -blockers is unsuccess- ful in patients with stable angina (Class IIa; Level of Evidence CCBs are added to, or substituted for, -blockers when BP remains elevated, when angina persists, or when drug side effects or contraindications mandate.171 Long-acting dihydropyr- idine agents are preferred over nondihydropyridines (diltiazem Rosendorff et al Treatment of Hypertension in Patients With CAD 1387 or verapamil) for use in combination with -blockers to avoid excessive bradycardia or heart block. Diltiazem or verapamil should not be used in patients with HF or LV systolic dysfunc- and short-acting nifedipine should be avoided because it causes reflex sympathetic activation and worsening myocardial Although CCBs are useful in the management of hyperten- sion in patients with stable angina, there is no consensus about their role in preventing cardiovascular events in patients with established CAD. The INVEST investigators randomized >22000 hypertensive patients with chronic CAD to the non- dihydropyridine CCB verapamil or the -blocker atenolol.116 By 24 months, the ACE inhibitor trandolapril had to be added in 63% of verapamil patients and 52% of atenolol patients, and hydrochlorothiazide was added in 44% of verapamil and 60% of atenolol patients. 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. 