Zofenopril plus hydrochlorothiazide combination in the treatment of hypertension: an update

The fixed combination of zofenopril 30 mg plus hydrochlorothiazide 12.5 mg is indicated for the management of hypertensive patients whose blood pressure (BP) is not adequately controlled on zofenopril alone. In clinical trials, this combination therapy proved to be superior to monotherapy in reducing office and ambulatory BP. In this review, the authors have updated the current evidence on the efficacy of the zofenopril plus hydrochlorothiazide combination in light of the results of the recent ZODIAC study on previously monotherapy-treated uncontrolled hypertensive patients with associated cardiovascular risk factors. The trial documented a similar BP control under this combination and with irbesartan plus hydrochlorothiazide, but a larger reduction of high-sensitivity C-reactive protein, suggesting a potential protective effect against vascular inflammation. Thus, the fixed combination of zofenopril plus hydrochlorothiazide may have a particular place in the treatment of high-risk or monotherapy-treated uncontrolled hypertensive patients requiring a more prompt, intensive and sustained BP reduction, as recommended by the current guidelines.