====== Benazepril ======

Benazepril is a long-acting ACE inhibitor used primarily for hypertension and renal protection in proteinuric kidney disease.

It is less commonly used than lisinopril but remains clinically relevant.

Class:
→ [[cardio:raas:acei|ACE Inhibitors]]

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===== Mechanism of Action =====

• Inhibits Angiotensin-Converting Enzyme (ACE)
• ↓ Angiotensin II
• ↓ Aldosterone
• ↑ Bradykinin

Net Effects:
• ↓ Systemic vascular resistance
• ↓ Blood pressure
• ↓ Intraglomerular pressure
• ↓ Ventricular remodeling (class effect)

Mechanism identical to other ACE inhibitors.

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===== Unique Features =====

• Prodrug → converted to benazeprilat
• Long-acting (once-daily dosing common)
• Frequently used in hypertension and CKD

No major pharmacologic advantage over lisinopril, but effective and well tolerated.

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===== Indications =====

==== Hypertension ====
• Effective first-line therapy
• Often used in combination therapy

→ [[cardio:hypertension:start|Hypertension Module]]

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==== Chronic Kidney Disease / Proteinuria ====
• ↓ Intraglomerular pressure
• ↓ Proteinuria
• Slows CKD progression

Particularly useful in diabetic nephropathy.

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==== Heart Failure (HFrEF) ====
• Used similarly to other ACE inhibitors
• Mortality benefit expected as class effect

→ [[cardio:heart_failure:start|Heart Failure Module]]

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===== Dosing =====

Hypertension:
• Start: 10 mg once daily
• Usual range: 10–40 mg daily
• May divide twice daily if needed

Once-daily dosing typical.

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===== Pharmacokinetics =====

• Prodrug → activated in liver
• Renally cleared
• Half-life of active metabolite ~10–11 hours

Dose adjustment required in renal impairment.

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===== Adverse Effects =====

Class Effects:
• Dry cough
• Hyperkalemia
• Hypotension
• Angioedema (rare)
• Mild creatinine elevation

No clinically meaningful difference from other ACE inhibitors.

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===== Monitoring =====

Monitor:
• Serum creatinine
• Potassium

Check labs 1–2 weeks after initiation or dose adjustments.

Mild creatinine rise (<30%) is expected.

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===== Contraindications =====

• Pregnancy
• History of ACE inhibitor–induced angioedema
• Bilateral renal artery stenosis

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===== Clinical Pearls =====

✔ Long-acting ACE inhibitor  
✔ Commonly used in hypertension and CKD  
✔ Effective for proteinuria reduction  
✔ No major distinguishing advantage over lisinopril  
✔ Monitor potassium and renal function  

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Related:

→ [[cardio:raas:acei|ACE Inhibitors]]
→ [[cardio:raas:lisinopril|Lisinopril]]
→ [[cardio:raas:ramipril|Ramipril]]
→ [[cardio:start|Return to CV Modules]]