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Benazepril

Grade

Hypertension

Recommendations by ACVIM Stage

We recommend following ACVIM and similar consensus guidelines for identifying, evaluating, and managing systemic hypertension in dogs and cats (Acierno et al., 2018).

Choice of Antihypertensive Agents

  • ACEi/ARB: Because of their antiproteinuric effect and prevalence of CKD associated with secondary hypertension, RAAS inhibitors (ACEi Benazepril or  ARB Telmisartan) are first-line ACVIM antihypertensive agents in dogs. 

  • Adrenergic Blockers: alpha- and beta-adrenergic blockers are suitable for specific AVCIM-recognised hypertensive presentations such as pheochromocytoma or adrenal tumours.

Initial Treatment

  1. ACEi - Benazepril: 0.5-2.0 mg/kg, PO, q12h.

  2. ARB - Telmisartan: 1.0 mg/kg, PO, q24h.

ACVIM Hypertension Classification 

by the risk of TOD (Target Organ Damage) (Acierno et al., 2018)


  1. Normotensive: SBP <140 mm Hg  (minimal TOD risk) 

  2. Prehypertensive: SBP 140-159 mm Hg (low TOD risk) 

  3. Hypertensive: SBP 160-179 mm Hg (moderate TOD risk) 

  4. Severely hypertensive: SBP ≥180 mm Hg (high TOD risk)

Therapeutic Goals

  • TOD Reduction: Decreasing the likelihood of future TOD (i.e., decreasing SBP by at least 1 SBP substage over 2-3 weeks).

  • Proteinuria Reduction: Decreasing proteinuria preferably to <0.5) (i.e., urinary protein-to-creatinine [UPC] ratio decreased by ≥50%).

Secondary Hypertension 

  • 80% of canine hypertension is secondary; therefore, clinicians should address any underlying or associated condition where the hypertension is secondarily initiated (Acierno et al., 2018).

Therapeutics

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About Benazepril and Hypertension

Benazepril is a prodrug that inhibits the conversion of angiotensin-I to angiotensin-II by inhibiting angiotensin-converting enzyme (ACE) after being hydrolyzed in the liver to benazeprilat. 

Adverse Effects

  • Severe CHF: Monitor for progressive azotaemia, especially where aggressive diuresis has recently occurred. Avoid use in cardiac output failure due, for example, to aortic stenosis.

  • GI Distress: Typically anorexia, vomiting, and diarrhoea.

  • Hypotension:  Animals may experience excessive hypotension, and fatigue, lethargy, ataxia, and incoordination may be observed. 

  • Azotaemia: Renal dysfunction, azotaemia and hyperkalemia may occur. Plasma creatinine concentration may increase at the start of therapy in patients with CKD or dehydration.

Contraindications

  • AKI: Avoid use in animals at risk of azotaemia as use may decrease GFR and worsen azotemia

  • Hypersensitivity: Avoid use in patients with known hypersensitivity to ACE inhibitors.

  • Hyponatremia or sodium depletion: Avoid use. 

  • Hypotension:  Avoid use in animals with or at risk of hypotension. 

  • Hypovolemia:  Avoid use. 

  • Coronary or cerebrovascular insufficiency:  Avoid use. 

  • Pre-existing hematologic abnormalities: Avoid use. 

  • SLE or Collagen Vascular Disease: Avoid use (e.g., systemic lupus erythematosus [SLE]). 

Reproductive Safety

  • Pregnancy: Avoid use. Benazepril crosses the placenta. Embryotoxic effects (foetal urinary tract malformation) were seen in trials with laboratory animals (rats) at maternally non-toxic doses (SPC data).

  • Lactation: Benazepril is not expected to cause adverse effects in an infant being nursed. However, in some countries, its use is contraindicated during pregnancy and lactation (SPC data).

  • Male Fertility: No data located.

  • Female Fertility: Avoid use. Benazepril reduced ovary/oviduct weights in cats when administered daily at 10 mg/kg body weight for 52 weeks (SPC data).

  • Neonates: Benazepril is not expected to cause adverse effects in an infant being nursed (SPC data).

Interactions

  • Anti-hypertensive Agents: e.g. calcium channel blockers, β-blockers or diuretics), anaesthetics or sedatives may lead to additive hypotensive effects (SPC data).

  • NSAIDs: e.g., carprofen, meloxicam, robenacoxib): can lead to reduced anti-hypertensive efficacy or impaired renal function (SPC data).

Alternative Products 

  • We refer clinicians to current ACVIM hypertension recommendations. 

Alternative Protocols

  • We refer clinicians to current ACVIM hypertension recommendations. 

Evidence

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  1. Acierno, M.J., Brown, S., Coleman, A.E., Jepson, R.E., Papich, M., Stepien, R.L., Syme, H.M., 2018. ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 32, 1803–1822. https://doi.org/10.1111/jvim.15331

Monograph Details

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