mprovement of the Lipid Profile with Zofenopril in Hypertensive Patients with the Metabolic Syndrome

The effect of the anti-hypertensive drug zofenopril on metabolic parameters in patients with the metabolic syndrome (MetS) is currently unknown. The present study was conducted in order to evaluate whether zofenopril affects parameters involved in the atherosclerotic process. This open-label intervention study included 60 adult patients with essential hypertension that additionally had 2 or more of the following MetS criteria: waist circumference > 102 cm in men and > 88 cm in women, triglycerides > 150 mg/dl, high density lipoprotein cholesterol (HDL-C) < 40 mg/dl in men and < 50 mg/dl in women, and fasting glucose 100 mg/dl. Zofenopril reduced systolic blood pressure by 11% (p<0.001) and diastolic blood pressure by 7% (p=0.004). Zofenopril also decreased triglycerides by 24% (p=0.05) and apolipoprotein B levels by 7% (p=0.04). In addition, the drug improved the lipid profile by decreasing both small dense low density lipoprotein (LDL) cholesterol by 22% (p=0.04), as well as the proportion of the cholesterol of small dense LDL subfraction by 8% (p=0.04), whereas it significantly increased the large LDL cholesterol by 6% (p=0.05) and the proportion of the cholesterol of large LDL subfraction by 7% (p=0.05). Accordingly, mean LDL particle size was increased by 0.04% (p=0.05) with zofenopril. The reduction of small dense LDL subfractions was significantly correlated with the reduction of ApoB levels, even after correction for baseline values (Pearson correlation coefficient 0.8, p=0.03), and with the reduction of triglycerides (Spearman correlation coefficient 0.77, p=0.02). An additional effect of zofenopril was the reduction of the enzymatic activity of lipoprotein-associated phospholipase A2 (Lp-PLA2) by 9% (p=0.05). On the other hand, zofenopril did not influence glucose homeostasis and fibrinogen levels. In conclusion, zofenopril is an effective anti-hypertensive agent with additional favourable effects on the atherogenic dyslipidemia of MetS.