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

Benazepril Dosing for Adult Hypertension

For adults with hypertension, initiate benazepril at 10 mg once daily, with a maximum dose of 40 mg once daily, titrating based on blood pressure response. 1

Initial Dosing

• Start with 10 mg once daily as the minimal effective dose for most patients with mild-to-moderate hypertension 1, 2
• For patients with stage 2 hypertension (BP ≥160/100 mmHg), consider starting with combination therapy rather than monotherapy, pairing benazepril with a thiazide diuretic or calcium channel blocker 3
• The FDA label specifies an initial dose range of 0.2 mg/kg per day up to 10 mg/day for starting therapy 1

Dose Titration

• Titrate to 20 mg once daily if blood pressure targets are not achieved, as this dose provides clinically important blood pressure reduction in most patients 2
• Maximum dose is 40 mg once daily (or 0.6 mg/kg per day, not to exceed 40 mg) 1, 3
• Doses of 40-80 mg have been studied but provide only small additional reductions beyond 20 mg 2
• Monthly follow-up is recommended after initiation or dose changes until blood pressure target is reached 3

Dosing Frequency Considerations

• Once-daily dosing is preferred to promote adherence 3
• However, divided twice-daily dosing may provide superior trough blood pressure control compared to the same total daily dose given once daily 1
• If blood pressure control is inadequate at trough (morning readings before next dose), consider splitting the daily dose to twice-daily administration 1

Blood Pressure Targets

• Target BP <140/90 mmHg for patients without comorbidities 3
• Target BP <130/80 mmHg for patients with diabetes, chronic kidney disease, or known cardiovascular disease 3
• For patients with diabetes and albuminuria (UACR ≥30 mg/g), benazepril should be titrated to the maximum tolerated dose to reduce progressive kidney disease risk 3

Combination Therapy

• If target blood pressure is not achieved with benazepril monotherapy, add a thiazide-like diuretic (chlorthalidone or indapamide preferred) or long-acting dihydropyridine calcium channel blocker 3
• Combination therapy with hydrochlorothiazide or nifedipine achieves greater blood pressure lowering than benazepril alone 1, 4
• Never combine with another ACE inhibitor or ARB, as this increases adverse effects without additional benefit 3

Monitoring Requirements

• Monitor serum creatinine, eGFR, and potassium at baseline and at least annually during treatment 3
• More frequent monitoring is needed when combining with other agents that affect potassium (diuretics, mineralocorticoid receptor antagonists) 3
• Blood pressure should be measured at each visit during titration 3

Important Contraindications and Precautions

• Absolutely contraindicated in pregnancy—women of childbearing age must use reliable contraception 3
• Monitor for cough and angioedema, though these are reportedly less common with benazepril than with captopril 3
• Benazepril can be continued even as eGFR declines to <30 mL/min/1.73 m² for cardiovascular benefit, though close monitoring is essential 3