A double-blind, controlled, randomized trial compared the antihypertensive efficacy and safety of azilsartan with the angiotensin-converting enzyme inhibitor ramipril in patients with clinic systolic blood pressure (SBP) 150-180 mm Hg. In all, 884 patients were randomized to receive 20 mg azilsartan or 2.5 mg ramipril once daily for a period of 2 weeks, then force-titrated to 40 or 80 mg azilsartan or 10 mg ramipril for 22 weeks. The primary endpoint was change in trough, seated, clinic SBP. Mean patient age was 57±11 years. Mean baseline BP was 161.1±7.9/94.9±9.0 mm Hg. Clinic SBP was noted to fall by 20.6±0.95 and 21.2±0.95 mm Hg with azilsartan 40 and 80 mg vs. 12.2±0.95 mm Hg with ramipril. Adverse events leading to discontinuation were noted less frequently with azilsartan 40 and 80 mg (2.4% and 3.1%, respectively) in comparison with with ramipril (4.8%). Treatment of stage 1-2 hypertension was found to be more effective and better tolerated with azilsartan than ramipril. The findings were published in the Journal of Human Hypertension.