Minimal changes in mean heart rate (,2 beats per minute) and systolic BP (,3 mm Hg) occur in controlled studies. At maximal exercise, the rate pressure product is not increased, independent of age, or in the presence of diabetes mellitus, reactive airway disease, or heart failure.883 Ranola- zine is currently indicated for the treatment of chronic angina and may be used in combination with beta blockers, nitrates, dihydropyridine calcium channel blockers, ACE inhibitors, ARBs, and antiplatelet and lipid-lowering therapy. It should be prescribed only in low doses in combination with verap- amil or diltiazem, as described later. The lack of an effect on BP and heart rate makes ranolazine an attractive alternative in patients with bradycardia or low BP. Although ranolazine has been well studied in SIHD, the agent was not administered in the COURAGE (Clinical Outcomes Utilizing Revasculariza- tion and Aggressive Drug Evaluation) study,366 and further clinical evaluation is needed, especially of ranolazine as an element of intensive interventions for multiple risk factors. 