What is the recommended dose of Benazepril (Angiotensin-Converting Enzyme (ACE) inhibitor) for adults with hypertension?

Benazepril Dosing for Adult Hypertension

The recommended initial dose of benazepril for adults with hypertension is 10 mg once daily, with the typical effective dosing range being 10-40 mg daily, which can be given as a single dose or divided into twice-daily dosing for better trough control. 1

Initial Dosing Strategy

• Initial dose: 10 mg once daily
• Titration: If blood pressure control is inadequate, dose can be increased to 20 mg daily, then up to 40 mg daily
• Maximum dose: 80 mg daily, though doses above 40 mg provide only modest additional benefit 1, 2

Dosing Considerations Based on Hypertension Severity

• Stage 1 hypertension (SBP 130-139 or DBP 80-89 mmHg):

  • Start with single antihypertensive agent (benazepril 10 mg daily) 3
  • Titrate dose and add sequential agents as needed to achieve BP target

• Stage 2 hypertension (SBP ≥140 or DBP ≥90 mmHg) or BP >20/10 mmHg above target:

  • Consider initiating with two antihypertensive agents of different classes 3
  • Benazepril can be combined with a thiazide diuretic or calcium channel blocker for enhanced efficacy 4

Dosing Schedule Options

• Once-daily dosing: Convenient and promotes adherence
• Twice-daily dosing: May provide better blood pressure control at trough (morning) levels 1
• Clinical studies show benazepril lowers blood pressure within 1 hour, with peak effect at 2-4 hours, and antihypertensive effect persisting for 24 hours 1

Special Populations

• Patients with volume depletion (e.g., on diuretics):

  • Start with lower dose (5 mg) under close medical supervision 1

• Renal impairment:

  • Monitor renal function and potassium levels at baseline and at least annually 3
  • Dose adjustment may be needed in severe renal impairment

• Elderly patients:

  • Standard adult dosing is generally appropriate
  • Monitor more closely for hypotension, especially if initiating with combination therapy 3

Combination Therapy

• Adding a thiazide diuretic to benazepril provides greater blood pressure reduction than benazepril alone 1, 2
• Benazepril tends to reduce potassium loss associated with diuretic therapy 1
• Combination therapy may be suitable for patients with more severe hypertension 4

Monitoring

• Follow up monthly after initiation or change in medication until target BP is reached 3
• Monitor serum creatinine, estimated GFR, and potassium levels at baseline and at least annually 3
• For patients at goal BP, follow-up every 3-5 months is suggested 3

Common Pitfalls to Avoid

1. Starting with too low a dose: The minimal effective once-daily dose is 10 mg; lower doses may not provide adequate BP reduction 1

2. Inadequate follow-up: Monthly follow-up is recommended after initiation until target BP is achieved 3

3. Failure to monitor electrolytes: ACE inhibitors can increase serum potassium, especially when combined with potassium-sparing agents 3

4. Pregnancy: Benazepril is contraindicated in pregnancy due to risk of fetal toxicity 5

5. Cough: ACE inhibitor-induced cough may occur (reported in 21% of patients in one study) 6

Benazepril has been shown to be effective in lowering blood pressure with a good safety profile and minimal adverse effects on renal function or metabolic parameters 7, 8.