What is the usual dose of Ramipril (Angiotensin-Converting Enzyme inhibitor) for hypertension?

Ramipril Dosing for Hypertension

For hypertension, start ramipril at 2.5 mg once daily and titrate to a usual maintenance dose of 2.5-20 mg daily, with most patients controlled on 2.5-5 mg once daily. 1

Initial Dosing

• Begin with 2.5 mg once daily in patients not receiving a diuretic 1
• If volume depletion is suspected (e.g., current diuretic use) or renal artery stenosis is present, start with 1.25 mg once daily 1
• For patients with renal impairment (creatinine clearance <40 mL/min), initiate at 1.25 mg once daily 1

Titration Strategy

• Adjust dose according to blood pressure response 1
• The usual maintenance range is 2.5-20 mg per day, administered as a single dose or divided into two equal doses 1
• In real-world practice, 41% of patients required only 2.5 mg and 81% were controlled on ≤5 mg once daily 2
• Clinical trials demonstrate dose-dependent efficacy: 28% response at 1.25 mg, 52% at 2.5 mg, 70% at 5 mg, and 78% at 10 mg 3

Dosing Frequency Considerations

• If antihypertensive effect diminishes toward the end of the 24-hour dosing interval, consider increasing the dose or switching to twice-daily administration 1
• The maximum dose is 20 mg daily for hypertension 1

Combination Therapy

• If blood pressure remains uncontrolled with ramipril monotherapy, add a diuretic rather than exceeding recommended doses 1
• When adding ramipril to existing diuretic therapy, reduce the diuretic dose if possible to minimize hypotension risk 1

Renal Impairment Adjustments

• For creatinine clearance <40 mL/min: start at 1.25 mg once daily and titrate to a maximum of 5 mg daily 1
• Establish baseline renal function before initiating therapy 1

Common Pitfalls to Avoid

• Do not combine ramipril with potassium supplements, potassium salt substitutes, or potassium-sparing diuretics without careful monitoring, as this can cause life-threatening hyperkalemia 1
• Monitor blood pressure for at least 2 hours after the initial dose, especially in volume-depleted patients 1
• The appearance of hypotension after the first dose does not preclude careful subsequent titration 1