Benazepril

What Does Benazepril Do?

Benazepril is an angiotensin-converting enzyme (ACE) inhibitor used primarily to reduce high blood pressure (hypertension). It helps treat heart failure and kidney disease linked to hypertension. 

How Does Benazepril Work? (the complicated stuff!)

Benazepril inhibits the conversion of angiotensin I to angiotensin II by competing for binding at the ACE enzyme. This inhibition results in lower plasma angiotensin II levels, decreasing its vasoconstrictive effects and promoting vasodilation. Additionally, benazepril reduces aldosterone secretion from the adrenal cortex, leading to decreased sodium retention and water absorption in the kidneys. Collectively, these mechanisms effectively lower blood pressure and reduce the workload on the heart, contributing to better management of conditions like hypertension and heart failure.

Drug Type and Category of Benazepril

Benazepril is classified as an angiotensin-converting enzyme (ACE) inhibitor. 

What dosage of Benazepril should you be taking?

General Dosage Guidelines ¹:

• Hypertension (High Blood Pressure):
• Initial Dose: Typically, the starting dose is 10 mg once daily.
• Maintenance Dose: Depending on blood pressure response, the dose may be adjusted to a range of 20 to 40 mg per day, administered as a single dose or divided into two doses.
• Heart Failure:
• Initial Dose: A lower starting dose of 5 mg once daily is often recommended.
• Maintenance Dose: The dose may be gradually increased, based on patient tolerance and clinical response, up to a maximum of 20 mg daily, given in one or two divided doses.

Important Considerations:

• Renal Impairment: Patients with kidney problems may require dosage adjustments, and renal function should be monitored regularly.
• Elderly Patients: Caution is advised, and lower initial doses may be considered due to the increased likelihood of reduced renal function.
• Combination with Diuretics: For patients already on diuretic therapy, initiating benazepril at a lower dose can help prevent excessive blood pressure reduction.

Administration Tips:

• Benazepril can be taken with or without food.
• It's essential to take the medication at the same time each day to maintain consistent blood levels.
• If a dose is missed, take it as soon as remembered. If it's near the time of the next dose, skip the missed dose and resume the regular schedule. Do not double the dose to catch up.

Monitoring:

• Regular blood pressure checks are crucial to assess the effectiveness of the therapy.
• Periodic blood tests may be necessary to monitor kidney function and potassium levels, as ACE inhibitors can affect renal function and electrolyte balance.

What are the side-effects of Benazepril?

Common Side Effects:

1. Cough
• A persistent, dry cough is a well-known side effect of ACE inhibitors, including benazepril.
• It typically resolves after discontinuation of the medication.
2. Dizziness or Lightheadedness
• Often occurs when starting the medication or when the dose is increased due to a drop in blood pressure.
• To minimise, rise slowly from sitting or lying positions.
3. Headache
• Mild headaches may occur, especially during the initial treatment phase.
4. Fatigue
• Some individuals may feel unusually tired or lethargic.
5. Nausea
• Stomach discomfort or mild nausea can occur, particularly at the start of treatment.

Less Common Side Effects:

1. Rash or Skin Reactions
• Benazepril may cause mild skin rashes or itching.
2. Changes in Taste
• Some patients report a metallic or altered taste.
3. Diarrhea or Constipation
• Gastrointestinal disturbances are less frequent but possible.
4. Increased Potassium Levels (Hyperkalemia)
• May lead to symptoms like muscle weakness, irregular heartbeat, or tingling sensations.
• Regular blood tests can help monitor potassium levels.

Serious Side Effects (Rare):

1. Swelling (Angioedema)
• Swelling of the face, lips, tongue, or throat, potentially causing difficulty breathing or swallowing.
• Requires immediate medical attention as it can be life-threatening.
2. Severe Allergic Reactions (Anaphylaxis)
• Symptoms include rash, itching, severe dizziness, and trouble breathing.
• Emergency treatment is necessary.
3. Kidney Function Impairment
• Can cause worsening kidney function, especially in those with preexisting kidney issues.
• Symptoms: Reduced urination, swelling in hands or feet.
4. Low Blood Pressure (Hypotension)
• May result in severe dizziness, fainting, or shock.
• Often seen in patients who are volume-depleted or on diuretics.
5. Liver Dysfunction
• Rare cases of liver injury may occur. Symptoms include jaundice (yellowing of the skin or eyes) and dark urine.

Precautions to Minimise Side Effects:

1. Hydration
• Maintain proper hydration to avoid dizziness or low blood pressure.
2. Monitor Potassium and Kidney Function
• Regular blood tests can help identify imbalances early.
3. Avoid Potassium-Rich Diets or Supplements
• Excess potassium can exacerbate hyperkalemia risks.

Interactions

Medications That May Increase the Risk of Hyperkalemia (High Potassium Levels)

1. Potassium-Sparing Diuretics
• Examples: Spironolactone, eplerenone, amiloride.
• Combined use can significantly raise potassium levels.
2. Potassium Supplements
• Increases the risk of dangerously high potassium levels.
3. Other ACE Inhibitors or ARBs (Angiotensin II Receptor Blockers)
• Examples: Losartan, valsartan.
• Using ACE inhibitors with ARBs is generally avoided to reduce the risk of hyperkalemia and kidney dysfunction.

Medications That May Increase the Risk of Hypotension (Low Blood Pressure)

1. Diuretics
• Examples: Furosemide, hydrochlorothiazide.
• May potentiate the blood pressure-lowering effects of benazepril, especially in volume-depleted patients.
2. Anesthetics or Antihypertensive Drugs
• Examples: Beta-blockers (metoprolol), calcium channel blockers (amlodipine).
• Combined use can cause excessive blood pressure reduction.

Medications That May Decrease the Effectiveness of Benazepril

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
• Examples: Ibuprofen, naproxen.
• Can reduce the antihypertensive effect and increase the risk of kidney damage.
2. Rifampin
• May reduce the effectiveness of benazepril by speeding up its metabolism.

Increased Risk of Kidney Damage

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
• Especially in older adults or those with preexisting kidney conditions.
2. Lithium
• Benazepril may reduce lithium clearance, increasing the risk of lithium toxicity.

Medications That Mask Symptoms or Enhance Effects

1. Diabetes Medications (Insulin or Oral Antidiabetics)
• Examples: Metformin, glimepiride.
• Benazepril may enhance the blood sugar-lowering effect, increasing the risk of hypoglycemia.
2. Beta-Blockers
• Examples: Propranolol, atenolol.
• May mask signs of low blood sugar (e.g., rapid heartbeat).

Substances That May Interact

1. Alcohol
• Can exacerbate the blood pressure-lowering effects, causing dizziness or fainting.
2. Salt Substitutes
• Often high in potassium, they can increase the risk of hyperkalemia.

Special Considerations

• Combination with Aliskiren:
• The combination of benazepril and aliskiren (a direct renin inhibitor) is not recommended, especially in patients with diabetes or kidney impairment, due to increased risk of kidney damage and hyperkalemia.
• Pregnancy:
• Benazepril is contraindicated during pregnancy due to potential harm to the fetus.

Natural Alternatives to Benazepril

1. Dietary Interventions

• DASH Diet (Dietary Approaches to Stop Hypertension)
• Focuses on reducing sodium intake while emphasising fruits, vegetables, whole grains, and lean protein. This diet is proven to lower blood pressure².
• Increased Potassium Intake
• Foods rich in potassium, such as bananas, spinach, and sweet potatoes, help counteract sodium's effects on blood pressure³.
• Reduce Sodium Intake
• Limiting sodium to less than 2,300 mg per day can significantly lower blood pressure⁴. However, good quality salt is very important for the body so you should speak to a holistic nutritionist if you want more information about this. 

2. Herbal Remedies

• Hibiscus Tea
• Studies have shown that drinking hibiscus tea can reduce both systolic and diastolic blood pressure due to its diuretic and vasodilatory effects⁵.
• Garlic
• Garlic has been found to lower blood pressure by promoting the production of nitric oxide, which relaxes blood vessels⁶.
• Hawthorn (Crataegus spp.)
• Used traditionally for heart health, hawthorn may improve circulation and reduce blood pressure⁷.

3. Physical Activity

• Aerobic Exercise
• Regular physical activity, such as brisk walking, jogging, or swimming, can reduce systolic blood pressure by 5–8 mmHg⁸.
• Resistance Training
• Incorporating strength exercises into your routine improves overall cardiovascular health and lowers blood pressure⁹.
• Yoga and Deep Breathing
• Stress-reducing practices like yoga and controlled breathing exercises have shown benefits in lowering blood pressure¹⁰.

4. Supplements

• Magnesium
• Magnesium supplementation may help lower blood pressure by relaxing blood vessels and improving overall vascular health¹¹.
• Coenzyme Q10 (CoQ10)
• CoQ10 has antioxidant properties and has been associated with reductions in blood pressure¹².
• Omega-3 Fatty Acids
• Found in fish oil, omega-3 fatty acids can reduce blood pressure and inflammation¹³.

5. Stress Management

• Mindfulness and Meditation
• Practices such as mindfulness meditation reduce stress hormones that can contribute to high blood pressure¹⁴.
• Acupuncture
• Acupuncture may help lower blood pressure by improving blood flow and balancing the body's stress response¹⁵. However, this may be a little far-fetched. 

Interesting facts about Benazepril

Benazepril is often combined with diuretics (e.g., hydrochlorothiazide) or calcium channel blockers (e.g., amlodipine) in fixed-dose combinations for enhanced blood pressure control.

Benazepril is available in generic forms, making it an affordable option for managing blood pressure compared to newer antihypertensives.

Disclaimer

This article is generated for informational purposes only. It was created in March 2025. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://www.evidence.nhs.uk/formulary/bnf/current
2. Sacks, F. M., et al. (2001). "Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet." New England Journal of Medicine.
3. Appel, L. J., et al. (1997). "A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure." New England Journal of Medicine.
4. He, F. J., et al. (2013). "Salt Reduction and Cardiovascular Disease." BMJ.
5. McKay, D. L., et al. (2010). "Hibiscus Sabdariffa L. Tea Lowers Blood Pressure in Pre-Hypertensive and Mildly Hypertensive Adults." Journal of Nutrition.
6. Ried, K., et al. (2008). "Effect of Garlic on Blood Pressure: A Systematic Review and Meta-Analysis." BMC Cardiovascular Disorders.
7. Walker, A. F., et al. (2002). "Hawthorn Extract for Treating Chronic Heart Failure: Meta-Analysis of Randomized Trials." American Journal of Medicine.
8. Pescatello, L. S., et al. (2004). "Exercise and Hypertension: Recent Advances." Current Hypertension Reports.
9. Cornelissen, V. A., et al. (2013). "Exercise Training for Blood Pressure: A Systematic Review and Meta-Analysis." Journal of Hypertension.
10. Cramer, H., et al. (2014). "Yoga for Hypertension: A Systematic Review and Meta-Analysis." American Journal of Hypertension.
11. Zhang, X., et al. (2016). "Magnesium and Blood Pressure: A Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials." Hypertension.
12. Rosenfeldt, F. L., et al. (2007). "Coenzyme Q10 in the Treatment of Hypertension: A Meta-Analysis." Journal of Human Hypertension.
13. Geleijnse, J. M., et al. (2002). "Fish Consumption and Risk of Stroke." Stroke.
14. Hughes, J. W., et al. (2013). "Mindfulness-Based Stress Reduction for Hypertension." American Journal of Hypertension.
15. Flachskampf, F. A., et al. (2007). "Randomized Trial of Acupuncture to Lower Blood Pressure." Circulation.