There was a relatively high use of revascularization before random- ization in the PEACE trial, which may have contributed to the low event rate. The investigators concluded that ACE inhibitors might not be necessary as routine therapy in low-risk IHD patients with preserved LV function, especially those who have received intensive treatment with revascularization and lipid-lower- ing agents. Thus, 2 large studies in high-cardiovascular-risk patients (HOPE and EUROPA) showed cardiovascular protec- tive effects by ACE inhibitors, and 1 study in low-cardiovas- cular-risk patients (PEACE) did not. The Ongoing Telmisartan Alone and In Combination with Ramipril Global Endpoint Trial (ONTARGET)90 trial random- ized 25620 patients, of whom 74% had a history of CAD, to the ACE inhibitor ramipril (10 mg/d), the ARB telmisar- tan (80 mg/d), or the combination of these 2 drugs. After a median follow-up of 4.7 years, there was no difference in the primary outcome of cardiovascular death, nonfatal MI, non- fatal stroke, and hospitalization for HF among the 3 groups. In the combination treatment group, there was an increased risk of hypotensive symptoms, syncope, and renal dysfunction compared with those in the ramipril group. The investigators concluded that ramipril and telmisartan had similar benefits but that the combination of the ACE inhibitor and ARB in this high-cardiovascular-risk group was associated with more side effects and no increase in benefit. 2.1.4. Angiotensin Receptor Blockers Several ARBs have been shown to reduce the incidence or severity of IHD events, the progression of renal disease in type 2 diabetes mellitus, and cerebrovascular events. ARBs are often considered to be an alternative therapy in individu- als with cardiovascular disease who are intolerant of ACE inhibitors. 