exercise tests where there is no contraindication. We use (i blockers in addition to aspirin in patients with hypertension and angina and consider them in those whom we assess to be at high risk. In the remaining asymptomatic low risk group we do not think that the potential additional benefit from 0 blockers justifies their use. The potential side effects (reduction in exercise tolerance, a general feeling ofdepressed activitv, and sleep disturbance) are precisely those that should be avoided

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... n subjects encouraged to take an aggressive approach to exercise and return to work. We therefore are satisfied, unlike Drs Eccles and Bradshaw, that their study reflects good practice, being disappointed only that use of a single prophylactic agent was achieved in 86% rather than 95% of patients. One must allow for a small percentage of patients who wish to forget all about their infarct and not take prophylactic medication at all. Until the necessary clinical trial is done we will continue to manage our patients in a way that we believe is based on a fair assessment of the available evidence and not on a clinical trial that has not even been done, let alone published.