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: → ACE Inhibitors

• 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.

• 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.

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

→ Hypertension Module

• ↓ Intraglomerular pressure • ↓ Proteinuria • Slows CKD progression

Particularly useful in diabetic nephropathy.

• Used similarly to other ACE inhibitors • Mortality benefit expected as class effect

→ Heart Failure Module

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

Once-daily dosing typical.

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

Dose adjustment required in renal impairment.

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

No clinically meaningful difference from other ACE inhibitors.

Monitor: • Serum creatinine • Potassium

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

Mild creatinine rise (<30%) is expected.

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

✔ 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

Related:

→ ACE Inhibitors → Lisinopril → Ramipril → Return to CV Modules