The VALIANT trial found valsartan to be noninferior to captopril, although it did not show superiority.61 The Evaluation of Losartan in the Elderly (ELITE) II trial compared the efficacy of losartan 50 mg/d with captopril 150 mg/d and found that the rates of all- cause mortality and sudden death or resuscitated arrests for the losartan group were not significantly different from those for the captopril group.257 The Valsartan Heart Failure Trial (Val-HeFT) assessed the efficacy of valsartan at doses up to 320 mg/d added to standard therapy for reducing morbidity and mortality in patients with HF.258 Patients receiving val- sartan demonstrated a 13.2% reduction in the combined end point of cardiovascular mortality and morbidity compared with patients receiving placebo. 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. 