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Zofenopril: Blood pressure control and cardio-protection
Affiliations- Unit of Internal Medicine, Policlinico S. Orsola, University of Bologna, Italy
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
- University of Milano-Bicocca, Milan and Policlinico di Monza, Monza, Italy
open access
Abstract
Current hypertension guidelines suggest various strategies to reduce blood pressure levels, thereby reducing cardiovascular events: combinations of drugs with different mechanisms of action, such as an angiotensin converting enzyme inhibitors (ACEIs) and a diuretic, are the cornerstone of the modern treatment of hypertension, also as initial therapy. Among ACEIs, zofenopril has been shown to be effective in the management of hypertension both as monotherapy and in combination with a diuretic: zofenopril/hydrochlorothiazide fixed dose combination is particularly useful to improve treatment adherence through simplification of treatment regimen. Moreover, thanks to the sulfhydryl group, zofenopril has some peculiar properties (higher lipophilicity and tissue penetration, lower bradykinin-dependent effect, higher affinity for, and more persistent binding to, tissue ACE, significant antioxidant effect), which may account for the cardioprotective effects of the drug demonstrated in both pre-clinical studies and randomized clinical trials. The positive impact of zofenopril on clinical outcomes has been extensively documented by the SMILE program, including several clinical trials in patients with different conditions of myocardial ischemia treated with zofenopril: the results of the SMILE program, demonstrating the benefits of zofenopril vs. placebo and other ACEIs, emphasize the importance of a differentiated approach to patients with ischemic heart disease, based on a careful choice of the adopted agent, in order to improve the overall impact of pharmacological treatment on clinical outcomes.
Abstract
Current hypertension guidelines suggest various strategies to reduce blood pressure levels, thereby reducing cardiovascular events: combinations of drugs with different mechanisms of action, such as an angiotensin converting enzyme inhibitors (ACEIs) and a diuretic, are the cornerstone of the modern treatment of hypertension, also as initial therapy. Among ACEIs, zofenopril has been shown to be effective in the management of hypertension both as monotherapy and in combination with a diuretic: zofenopril/hydrochlorothiazide fixed dose combination is particularly useful to improve treatment adherence through simplification of treatment regimen. Moreover, thanks to the sulfhydryl group, zofenopril has some peculiar properties (higher lipophilicity and tissue penetration, lower bradykinin-dependent effect, higher affinity for, and more persistent binding to, tissue ACE, significant antioxidant effect), which may account for the cardioprotective effects of the drug demonstrated in both pre-clinical studies and randomized clinical trials. The positive impact of zofenopril on clinical outcomes has been extensively documented by the SMILE program, including several clinical trials in patients with different conditions of myocardial ischemia treated with zofenopril: the results of the SMILE program, demonstrating the benefits of zofenopril vs. placebo and other ACEIs, emphasize the importance of a differentiated approach to patients with ischemic heart disease, based on a careful choice of the adopted agent, in order to improve the overall impact of pharmacological treatment on clinical outcomes.
Keywords
zofenopril, hypertension, coronary artery disease, cardioprotection, nitric oxide, vasodilation, sulfhydrylic angiotensin converting enzyme inhibitors, fixed dose combination
About this articleTitle
Zofenopril: Blood pressure control and cardio-protection
Journal
Issue
Article type
Review Article
Pages
305-318
Published online
2021-09-30
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6837
Article views/downloads
1797
DOI
Pubmed
Bibliographic record
Cardiol J 2022;29(2):305-318.
Keywords
zofenopril
hypertension
coronary artery disease
cardioprotection
nitric oxide
vasodilation
sulfhydrylic angiotensin converting enzyme inhibitors
fixed dose combination
Authors
Claudio Borghi
Giuseppe Ambrosio
Philippe Van De Borne
Giuseppe Mancia
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