Comparison of home and office blood pressure in hypertensive patients treated with zofenopril or losartan

In a parallel double-blind multicentre study, 375 hypertensive patients were enrolled and treated with either the angiotensin-converting enzyme inhibitor (ACEI) zofenopril 30 mg once daily (titration 60 mg od) or the angiotensin II type 1 receptor (AT1) antagonist losartan 50 mg od (titration 100 mg od). Patients with mild to moderate hypertension, defined as a diastolic blood pressure (DBP) between 95 and 110 mmHg in the sitting position without other signs of cardiovascular disease were enrolled and treated for 12 weeks. BP was assessed in the clinic, and self-measured by the patients at home during a working day and a holiday, as well as before and at the clinic follow-ups. Systolic (SBP) and DBP were significantly reduced in both treatment groups to a similar extent at the end of the 12-week study. However, the immediate or early reduction of DBP as well as DBP reduction over the first month was significantly greater with zofenopril (p= 0 .01 and p= 0 .003, respectively) compared with losartan treatment. After 3 months of treatment and dose up-titration, clinic BP reductions were similar in both groups. However, more subjects with losartan had used a higher dose step (42.1%) compared with zofenopril (33.1%). Home BP assessments demonstrated that systolic and diastolic pressures were substantially lower than the BP measurements made by sphygmomanometer in the clinic. In particular, assessments 2-3 days before the clinic visits during working days and holidays were characteristically lower, while the measurements during the clinic visits were largely similar to the conventional BP measurements by the doctor. The number and the severity of adverse events, related to the study medications, were largely benign and similar in both groups. The present study demonstrates that zofenopril in clinically recommended doses is at least therapeutically equivalent to losartan treatment, when assessed by conventional sphygmomanometry at the doctor's office or at home by self-measured BP assessments by the patients. Zofenopril however, induces a more rapid initial lowering of BP over the first month of therapy.