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Clearly patients at high risk from macrovascular disease and in particular myocardial infarction. We would have to say that antihypertensive treatment with a calcium channel blockers or ICE inhibitor is of proven benefit and if an antihypertensive treatment is not ACE inhibitor then ramipril should be added. There is no true evidence base for stopping these patients smoking or for antilipid therapy. If coronary heart disease risk approximately 40% over next 10 years, with the use of statins, lowering risk by 1/4, to prevent 1 myocardial infarction we need to treat 10 men for 10 years.