A compound having structural Formula I: and the pharmaceutically acceptable salts thereof wherein: X is O, NH, S or SO 2; p is an integer selected from 1 (one) or 2 (two), and q is an integer selected from 1 (one) or 2 (two), provided that only one of p and q can be 2; Z 1 is R 1 is -H or -C 1-4 alkyl; R 2 is -H, -F, -Cl, -C 1-6 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; R 3 is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl, -OC 1-4 alkyl or N-tetrazolyl optionally substituted with -CH 3; R 4 is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl, -OC 1-4 alkyl or N-tetrazolyl optionally substituted with -CH 3; or R 3 and R 4 are joined together with the the phenyl ring to which they are attached to form a bicyclic ring system that is: wherein R is -H or -C 1-4 alkyl; R 5 is -H, -F, -Cl, -CN, -C 1-4 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; provided that when R 3 and R 4 are not joined together, then either (a) one of R 3, R 4 or R 5 is -CN and the others are not -CN, or (b) one of R 3 or R 4 is N-tetrazolyl optionally substituted with -CH 3 and the other is not N-tetrazolyl optionally substituted with -CH 3; R 6 is -H or -C 1-6 alkyl; Z 2 is n is an integer selected from 1 (one) or 2 (two); m is an integer selected from 1 (one) or 2 (two); R 2a is -H, -F, -Cl, -C 1-6 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; R 3a is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl, -OC 1-4 alkyl or N-tetrazolyl optionally substituted with -CH 3; R 4a is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl, -OC 1-4 alkyl or N-tetrazolyl optionally substituted with -CH 3; or R 3a and R 4a are joined together with the phenyl ring to which they are attached to form: wherein R a is -H or -C 1-4 alkyl; R 5a is -H, -F, -Cl, -CN, -C 1-4 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; provided that when R 3a and R 4a are not joined together, then either (a) only one of R 3a, R 4a or R 5a is -CN and the others are not -CN, or (b) only one of R 3a or R 4a is N-tetrazolyl optionally substituted with -CH 3 and the other is not N-tetrazolyl optionally substituted with -CH 3; R 7 is is independently at each occurrence -H or -C 1-3 alkyl; R 8 is -H, -F, -Cl, -C 1-6 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; R 9 is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; R 10 is -H or -CH 3; and R 11 is -H or -CH 3. X is O, NH, S or SO 2; p is an integer selected from 1 (one) or 2 (two), and q is an integer selected from 1 (one) or 2 (two), provided that only one of p and q can be 2; Z 1 is R 1 is -H or -C 1-4 alkyl; R 2 is -H, -F, -Cl, -C 1-6 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; R 3 is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl, -OC 1-4 alkyl or N-tetrazolyl optionally substituted with -CH 3; R 4 is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl, -OC 1-4 alkyl or N-tetrazolyl optionally substituted with -CH 3; or R 3 and R 4 are joined together with the the phenyl ring to which they are attached to form a bicyclic ring system that is: wherein R is -H or -C 1-4 alkyl; R 5 is -H, -F, -Cl, -CN, -C 1-4 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; provided that when R 3 and R 4 are not joined together, then either (a) one of R 3, R 4 or R 5 is -CN and the others are not -CN, or (b) one of R 3 or R 4 is N-tetrazolyl optionally substituted with -CH 3 and the other is not N-tetrazolyl optionally substituted with -CH 3; (a) one of R 3, R 4 or R 5 is -CN and the others are not -CN, or (b) one of R 3 or R 4 is N-tetrazolyl optionally substituted with -CH 3 and the other is not N-tetrazolyl optionally substituted with -CH 3; R 6 is -H or -C 1-6 alkyl; Z 2 is n is an integer selected from 1 (one) or 2 (two); m is an integer selected from 1 (one) or 2 (two); R 2a is -H, -F, -Cl, -C 1-6 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; R 3a is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl, -OC 1-4 alkyl or N-tetrazolyl optionally substituted with -CH 3; R 4a is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl, -OC 1-4 alkyl or N-tetrazolyl optionally substituted with -CH 3; or R 3a and R 4a are joined together with the phenyl ring to which they are attached to form: wherein R a is -H or -C 1-4 alkyl; R 5a is -H, -F, -Cl, -CN, -C 1-4 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; provided that when R 3a and R 4a are not joined together, then either (a) only one of R 3a, R 4a or R 5a is -CN and the others are not -CN, or (b) only one of R 3a or R 4a is N-tetrazolyl optionally substituted with -CH 3 and the other is not N-tetrazolyl optionally substituted with -CH 3; (a) only one of R 3a, R 4a or R 5a is -CN and the others are not -CN, or (b) only one of R 3a or R 4a is N-tetrazolyl optionally substituted with -CH 3 and the other is not N-tetrazolyl optionally substituted with -CH 3; R 7 is is independently at each occurrence -H or -C 1-3 alkyl; R 8 is -H, -F, -Cl, -C 1-6 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; R 9 is -H, -F, -Cl, -CN, -C 1-6 alkyl, -C 3-6 cycloalkyl or -OC 1-4 alkyl; R 10 is -H or -CH 3; and R 11 is -H or -CH 3.