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International Journal of Hypertension
Volume 2015, Article ID 139465, 12 pages
Clinical Study

Blood Pressure Response to Zofenopril or Irbesartan Each Combined with Hydrochlorothiazide in High-Risk Hypertensives Uncontrolled by Monotherapy: A Randomized, Double-Blind, Controlled, Parallel Group, Noninferiority Trial

1L. Sacco Hospital, 20157 Milano, Italy
2Italian Institute of Telemedicine, Solbiate Arno, 21048 Varese, Italy
3Istituto Auxologico Italiano and University of Milano-Bicocca, 20149 Milano, Italy

Received 15 April 2015; Revised 25 June 2015; Accepted 2 July 2015

Academic Editor: Francesco Cappuccio

Copyright © 2015 Ettore Malacco et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In this randomized, double-blind, controlled, parallel group study (ZENITH), 434 essential hypertensives with additional cardiovascular risk factors, uncontrolled by a previous monotherapy, were treated for 18 weeks with zofenopril 30 or 60 mg plus hydrochlorothiazide (HCTZ) 12.5 mg or irbesartan 150 or 300 mg plus HCTZ. Rate of office blood pressure (BP) response (zofenopril: 68% versus irbesartan: 70%; ) and 24-hour BP response (zofenopril: 85% versus irbesartan: 84%; ) was similar between the two treatment groups. Cardiac and renal damage was equally reduced by both treatments, whereas the rate of carotid plaque regression was significantly larger with zofenopril. In conclusion, uncontrolled monotherapy treated hypertensives effectively respond to a combination of zofenopril or irbesartan plus a thiazide diuretic, in terms of either BP response or target organ damage progression.