systolic BP <120 mmHg, presenting heart rate >110 bpm, or increased time since onset of symptoms of STEMI. The benefit of beta blockers for secondary prevention has been established in numerous trials conducted in the prereperfu- sion era and appears to be greatest for patients with MI com- plicated by HF, LV dysfunction, or ventricular arrhythmias.418 The long-term duration of routine beta-blocker therapy after uncomplicated MI in patients without HF or hypertension has not been prospectively addressed. AHA/ACCF secondary prevention guidelines recommend a 3-year treatment course in this patient subset.257 8.2. Renin-Angiotensin-Aldosterone System Inhibitors: Recommendations Class I 1. An angiotensin-converting enzyme (ACE) inhibitor should be administered within the first 24 hours to all patients with STEMI with anterior location, HF, or ejection fraction (EF) less than or equal to 0.40, (Level of Evidence: A) 2. An angiotensin receptor blocker (ARB) should be given to patients with STEMI who have indications for but are intolerant of ACE inhibitors.424,425 (Level of Evidence: B) 3. An aldosterone antagonist should be given to pa- tients with STEMI and no contraindications who are already receiving an ACE inhibitor and beta blocker and who have an EF less than or equal to 0.40 and either symptomatic HF or diabetes mellitus.426 (Level of Evidence: B) Class IIa 1. ACE inhibitors are reasonable for all patients with STEMI and no contraindications to their use.427 429 (Level of Evidence: A) Oral ACE inhibitors reduce fatal and nonfatal major cardiovascular events in patients with STEMI.360,361,420,422,428 Their protective effects have been demonstrated indepen- dent of the use of other pharmacotherapies (ie, fibrinolytics, aspirin, and beta blockers). 