What is the recommended dose of Ramipril (Angiotensin-Converting Enzyme (ACE) inhibitor) for treating essential hypertension?

Ramipril Dosing for Essential Hypertension

For essential hypertension, the recommended initial dose of ramipril is 2.5 mg once daily, with a usual maintenance dosage range of 2.5 mg to 20 mg per day administered as a single dose or in two equally divided doses. 1

Initial Dosing and Titration

• The FDA-approved starting dose for patients not receiving a diuretic is 2.5 mg once daily 1
• Dose should be adjusted according to blood pressure response, with most patients requiring ≤5 mg once daily (81% of patients in clinical studies) 2
• The minimum effective dose of ramipril for hypertension is 2.5 mg once daily, as demonstrated in controlled clinical trials 3
• In patients with renal impairment, the recommended initial dose is lower at 1.25 mg once daily, with titration up to a maximum of 5 mg daily 1

Maintenance Dosing

• The usual maintenance dosage range is 2.5 mg to 20 mg per day, which can be administered as a single dose or divided into two equal doses 1
• For patients whose blood pressure is not adequately controlled with once-daily dosing, consider twice-daily administration if the antihypertensive effect diminishes toward the end of the dosing interval 1
• In clinical practice, 41% of patients achieve blood pressure control with 2.5 mg daily, and 81% require ≤5 mg daily 2

Special Considerations

• If blood pressure is not controlled with ramipril alone, a diuretic can be added for enhanced effect 1
• For patients with volume depletion (e.g., from diuretic use) or renal artery stenosis, initiate at a lower dose of 1.25 mg once daily to prevent excessive blood pressure reduction 1
• In elderly patients, lower doses may be appropriate as they may be more sensitive to the blood pressure-lowering effects 1, 4

Efficacy and Safety

• Ramipril effectively reduces blood pressure with a long duration of action suitable for once-daily administration in most patients 2
• In clinical trials, ramipril reduced mean systolic/diastolic blood pressure by approximately 19.9/14.7 mmHg from baseline 2
• Response rates are similar regardless of age, gender, and race 2
• Ramipril has demonstrated significant reductions in cardiovascular events beyond blood pressure control in high-risk patients 5

Administration

• Ramipril capsules can generally be swallowed whole 1
• For patients who have difficulty swallowing, the capsule can be opened and contents sprinkled on a small amount of applesauce or mixed in water or apple juice 1
• When using these alternative administration methods, the entire mixture should be consumed to ensure the full dose is received 1

Monitoring

• Monitor renal function and electrolytes within 1-2 weeks after initiating therapy or changing doses 6
• Avoid concomitant administration with potassium supplements, potassium salt substitutes, or potassium-sparing diuretics as this can lead to increases in serum potassium 1