The double-blind, multicentre, randomized, controlled trial AQUARIUS was designed to assess the effects of aliskiren in patients with CAD, systolic blood pressure in the range of 125–139 mmHg, and two additional cardiovascular risk factors. Coronary IVUS imaging data were available for 458 participants who had received either 300 mg of aliskiren or placebo for ≥72 weeks. “Although greater blood pressure lowering was observed in the aliskiren treatment group,” says Stephen Nicholls, one of the AQUARIUS investigators, “we did not observe significant slowing of disease progression.” Mean change in percent atheroma volume was −0.33% in the aliskerin group and 0.11% in the controls (P = 0.08), and the proportion of patients who showed atheroma regression was also not significantly different between the two groups.