Patients with coronary artery disease manifested by angina or myocardial infarction should be treated with a beta-blocking drug such as propranolol, carvedilol, or bisoprolol. If beta-blockers are contraindicated a calcium antagonist such as diltiazem sustained-release prepara¬tion may be tried. Dihydropyridine calcium antagonists increase heart rate and may precipitate heart failure and should not be used without a beta-blocking drug. A diuretic is always useful in this group of patients and combination with a beta blocker or ACE inhibitor provides benefit.
An ACE inhibitor is particularly useful if left ventricle dysfunction is present and the combination of a beta-blocker and an ACE inhibitor is advisable, because these two agents have been shown to be cardioprotective.
In patients with diabetes a combination of two or more drugs is usually needed to achieve the target goal of less than 130/80 mmHg. ACE inhibitors and angio-tensin receptor blockers favorably affect the progres¬sion of diabetic nephropathy and reduce albuminuria. Angiotensin receptor blockers have been shown to reduce progression to microalbuminuria. A beta-blocker is strongly recommended in addition to other agents because beta-blocking drugs have been shown to reduce cardiac death in patients at risk.

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