Recommended Dosing of Benazepril and Hydrochlorothiazide for African American Hypertensive Patients
For African American patients with hypertension, the recommended initial therapy should be a combination of a low-dose ARB with either a dihydropyridine calcium channel blocker (DHP-CCB) or a thiazide/thiazide-like diuretic rather than benazepril (ACE inhibitor) monotherapy. 1
Initial Treatment Approach
- For African American patients, thiazide diuretics or calcium channel blockers are more effective in lowering blood pressure than ACE inhibitors or ARBs when used as monotherapy 1
- The 2020 International Society of Hypertension guidelines specifically recommend starting with a low-dose ARB plus either a DHP-CCB or a thiazide/thiazide-like diuretic combination for Black patients 1
- ACE inhibitors like benazepril are less effective as monotherapy in African American patients compared to other racial groups 1, 2
Specific Dosing Recommendations
If using a combination that includes hydrochlorothiazide:
- Hydrochlorothiazide should be initiated at 12.5-25 mg daily 1, 3
- Higher doses of hydrochlorothiazide (25-50 mg) are more effective for blood pressure control in Black patients, as lower doses may not achieve maximum antihypertensive effect 3, 4
If benazepril must be used (e.g., in patients with comorbid CKD):
- The recommended starting dose of benazepril when used with a diuretic is 5 mg once daily 5
- Benazepril can then be titrated as needed up to 20-40 mg per day 5, 6
Important Clinical Considerations
- Black patients have a greater risk of angioedema with ACE inhibitors compared to other racial groups 1, 2
- Most African American patients with hypertension will require two or more antihypertensive medications to achieve adequate blood pressure control 1
- A single-tablet combination that includes either a diuretic or a CCB may be particularly effective in achieving BP control in Black patients 1
- The target blood pressure should be <130/80 mmHg, with a goal of reducing BP by at least 20/10 mmHg 1
Monitoring and Follow-up
- Monitor blood pressure control and aim to achieve target within 3 months 1
- When using hydrochlorothiazide 25 mg daily, monitor serum potassium levels as significant decreases have been observed at this dose 4
- If blood pressure remains uncontrolled on combination therapy, consider adding a diuretic (if not already included) or increasing to full doses 1
Special Situations
- For Black patients with comorbid conditions like CKD or heart failure, ACE inhibitors or ARBs may be indicated as part of the regimen despite reduced efficacy as monotherapy 1, 2
- Combination therapy with an ACE inhibitor/ARB plus either a calcium channel blocker or thiazide diuretic produces similar BP lowering in Black patients as in other racial groups 1