What are the dosing guidelines for benazepril (Angiotensin-Converting Enzyme (ACE) inhibitor) in treating hypertension?

Benazepril Dosing Guidelines for Hypertension

The recommended initial dose of benazepril for adults with hypertension is 10 mg once daily, with a usual maintenance dosage range of 20-40 mg per day administered as a single dose or in two equally divided doses. 1

Adult Dosing Recommendations

Standard Dosing

• Initial dose: 10 mg once daily
• Maintenance dose: 20-40 mg daily (single dose or divided twice daily)
• Maximum dose: 80 mg daily (provides increased response but with limited clinical experience) 1
• Divided dosing regimen (twice daily) is more effective in controlling trough (pre-dosing) blood pressure than the same total daily dose given once daily 1

Dosing with Diuretics

• For patients already on diuretic therapy:
  • Initial dose: 5 mg once daily 1
  • If blood pressure remains uncontrolled with benazepril alone, a low dose of diuretic may be added 1

Dosing in Renal Impairment

• For adults with GFR <30 mL/min/1.73 m² (serum creatinine >3 mg/dL):
  • Initial dose: 5 mg once daily
  • May titrate up to maximum of 40 mg daily as needed 1
  • Monitor renal function as benazepril can worsen kidney function 1

Pediatric Dosing

• For children 6 years and older:
  • Initial dose: 0.2 mg/kg once daily
  • Titrate as needed up to 0.6 mg/kg once daily
  • Maximum dose: 40 mg daily 1
• Not recommended for children under 6 years or with GFR <30 mL/min/1.73 m² 1

Place in Hypertension Treatment Algorithm

Benazepril, as an ACE inhibitor, is one of the first-line options for hypertension management according to current guidelines:

Step 1 Treatment

• ACE inhibitors (like benazepril) are appropriate first-line options along with ARBs, calcium channel blockers, and thiazide or thiazide-like diuretics 2
• For stage 2 hypertension (≥140/90 mmHg) or blood pressure >20/10 mmHg above target, combination therapy is preferred over monotherapy 2

Step 2 Treatment

• If blood pressure is not controlled by Step 1 treatment, use a CCB in combination with either an ACE inhibitor (like benazepril) or an ARB 3
• For Black patients of African or Caribbean family origin, consider an ARB in preference to an ACE inhibitor, in combination with a CCB 3

Step 3 Treatment

• If three drugs are required, the combination of ACE inhibitor or ARB, CCB, and thiazide-like diuretic should be used 3

Clinical Efficacy

• Benazepril lowers blood pressure within 1 hour, with peak reductions between 2-4 hours after dosing 1
• The antihypertensive effect persists for 24 hours 1
• Once-daily doses of 20-80 mg decrease blood pressure by approximately 6-12 mmHg systolic and 4-7 mmHg diastolic 24 hours after dosing 1
• The minimal effective once-daily dose is 10 mg, with greater blood pressure reductions seen with higher doses 1

Special Considerations

Combination Therapy

• Combination with thiazide diuretics provides greater blood pressure lowering than either agent alone 1
• ACE inhibitors like benazepril tend to reduce the potassium loss associated with diuretic therapy 1
• For patients not responding adequately to benazepril monotherapy, adding amlodipine can provide significant additional blood pressure reduction 4

Monitoring

• Regular monitoring of blood pressure, renal function, and electrolytes is recommended, particularly when adding or adjusting medications 2
• Home blood pressure monitoring is encouraged to guide treatment adjustments 2

Common Pitfalls and Caveats

• Cough is a common adverse effect of ACE inhibitors, reported in approximately 19% of patients 5
• ACE inhibitors are contraindicated during pregnancy 2
• When switching from monotherapy to combination therapy, allow sufficient time (2-4 weeks) to evaluate the full effect of dose adjustments 2
• For patients with diabetes or chronic kidney disease, an ACE inhibitor like benazepril should be included in the treatment regimen 2
• Benazepril can be prepared as a suspension (2 mg/mL) for patients who cannot swallow tablets, which can be stored for up to 30 days when refrigerated 1