Guide to Uses, Dosage & Side Effects

Benicar is a prescription blood pressure medication manufactured by Japanese drugmaker Daiichi Sankyo. Its active ingredient is olmesartan medoxomil, which is available as a generic formulation. The medication belongs to the angiotensin II receptor blocker, or ARB, drug class and works by blocking a hormone called angiotensin II, which causes blood vessel constriction and high blood pressure.

The U.S. Food and Drug Administration first approved brand name Benicar in 2002 to treat high blood pressure. Then in 2003, it approved Benicar HCT — a drug that contains both olmesartan with hydrochlorothiazide, a blood pressure drug from the thiazide diuretic drug class.

In clinical trials, one 20 mg dose of olmesartan reduced blood pressure by about 10/6 mmHg and 40 mg reduced it by about 12/7 mmHg.

Millions of Americans use Benicar and its generics each year.

The Centers for Disease Control and Prevention defines blood pressure as the force of blood against the artery walls as it circulates through the body.

Olmesartan medoxomil is one of the top 300 most prescribed drugs in the United States in 2017 with over 2 million prescriptions, according to the U.S. Department of Health and Human Services’ most recent Medical Expenditure Panel Survey data.

The combination of olmesartan medoxomil and hydrochlorothiazide was also in the top 300 most prescribed drugs in 2017 with over 1 million prescriptions.

What Does Benicar Treat?

Benicar is indicated for the treatment of hypertension, also known as high blood pressure. It is used to lower blood pressure.

Blood pressure rises as blood vessels constrict. While it’s normal for blood pressure to rise and fall throughout the day, health problems can develop for individuals whose blood pressure remains high for a longer period of time.

Blood pressure is measured by two numbers. The first number, referred to as systolic, represents pressure when the heart beats and is the higher number. The second number, referred to as diastolic, is the pressure when the heart rests in between beats. The blood pressure value is expressed as systolic over diastolic. For example, a systolic of 120 and diastolic of 80 is written as “120/80 mmHg”. A normal blood pressure is less than 120/80 mmHg.

When left unchecked, elevated blood pressure levels greatly increase a person’s risk for heart disease and stroke, leading causes of death in the United States. High blood pressure usually has no accompanying symptoms, so many people are unaware that there’s even a problem.

The Centers for Disease Control and Prevention estimated that 75 million adults have high blood pressure in the United States. It affects approximately one in every three adults.

Just over one half of individuals with high blood pressure are controlled. Seven in 10 of those adults with high blood pressure are taking a blood pressure medication. These individuals are sometimes prescribed a medication such as Benicar or a medication containing the ingredient olmesartan.

For patients suffering from high blood pressure, taking a medication for control, such as Benicar, can reduce the risk of heart attack and stroke.

Who Should Not Use Benicar?

Benicar can result in complications for fetuses, especially in the second and third trimesters, and some of these complications can be fatal to the fetus. Also, the drug should not be utilized in children under one, as it can negatively affect growth and development of the kidneys. Other individuals can experience adverse reactions when taking Benicar.

Benicar is not recommended for the following people:

• Pregnant women
• Nursing mothers
• Children under one year of age
• Patients with blood volume or salt depletion (a lower starting dose should be utilized)
• Patients with stiffening of renal arteries (also called renal artery stenosis)

Benicar Side Effects

The most common Benicar side effect is dizziness. Serious and less common side effects include facial edema (known as angioedema), high potassium levels (also known as hyperkalemia), low blood pressure (known as hypotension), and decreased kidney function.

Also, in 2013, the FDA released a safety announcement warning the public that Benicar has the potential to cause intestinal problems known as sprue-like enteropathy. Symptoms of drug-induced sprue-like enteropathy include severe, chronic diarrhea and substantial weight loss within months to years after beginning use of the medication.

Benicar can also result in fetal toxicity and is not recommended for women who are pregnant. Benicar should be discontinued as soon as possible when pregnancy is detected.

Common Side Effects (>1 percent occurrence)

• Back pain
• 
  Bronchitis
• 
  Increase of creatinine phosphokinase (CPK)
• 
  Diarrhea
• 
  Headache
• 
  Blood in urine
• 
  High blood sugar
• 
  Elevated triglyceride levels (fat in the blood)
• 
  Flu-like symptoms
• 
  Inflammation of pharynx or back of throat
• 
  Inflammation of mucous membrane inside the nose
• 
  Sinusitis

Less Common Side Effects (

• Chest pain
• 
  Fast heart rate
• 
  Peripheral edema
• 
  Weakness/lack of energy
• 
  Vertigo
• 
  Abdominal pain
• 
  Indigestion
• 
  Diarrhea
• 
  Nausea
• 
  High levels of cholesterol in blood
• 
  High concentration of fats in blood
• 
  Excess levels of uric acid in blood
• 
  Decreases in hemoglobin and hematocrit level
• 
  Elevations of liver enzymes and/or serum bilirubin levels
• 
  Increased blood creatinine levels
• 
  Joint pain
• 
  Arthritis
• 
  Muscle pain
• 
  Rhabdomyolysis (a condition causing destruction of skeletal muscle)
• 
  Rash
• 
  Acute kidney failure
• 
  Hair loss

Black Box Warning – Fetal Toxicity

A black box warning appears on a prescription drug’s label when the FDA wants to call attention to serious or life-threatening risks associated with its use. Benicar (olmesartan medoxomil) contains one of these warnings for fetal toxicity. The label says Benicar should be discontinued as soon as possible after pregnancy is detected. This is because olmesartan acts directly on the renin angiotensin system (a system in the body that regulates blood pressure), which can cause injury and death to the developing fetus.

The label says the risks are greater during the second and third trimesters. The risks include reduction of fetal renal function and increase in fetal and neonatal death.

This could lead to a decrease in amniotic fluid and result in fetal lung underdevelopment and skeletal deformations.

Potential neonatal adverse effects include:

• Skull underdevelopment
• Failure of kidneys to produce urine
• Low blood pressure
• Kidney failure
• Death

Benicar Dosages

Benicar comes in tablet form in three different prescription strengths: 5 milligrams (yellow/round pill), 20 milligrams (white/round pill), 40 milligrams (white/oval). This drug can be taken with or without food, and it can also be administered with a diuretic and/or other antihypertensive medications.

5 mg (yellow/round pill) dosage

20 mg (white/round pill) dosage

40 mg (white/oval) dosage

Dosage Information for Adults

• Recommended starting dosage of 20 milligrams once daily
• If further blood pressure reduction is required after two weeks of taking Benicar, the provider may increase the dose to 40 milligrams.
• Doses above 40 milligrams have not been shown to have any greater effect in patients.
• Twice-daily dosages do not appear to offer any advantage over the same total dose taken once daily.

Dosage Information for Children

• Dosing must be individualized
• Recommended starting dosage in children 6 years of age and older and weighing 44 to 77 pounds is 10 milligrams once daily
• If further reduction in blood pressure is required after two weeks of taking Benicar, the provider may increase the dose to a maximum of 20 milligrams once daily for those weighing under 77 pounds
• If further reduction in blood pressure is required after two weeks of taking Benicar, the provider may increase the dose to a maximum of 40 milligrams for those weighing over 77 pounds
• For children who cannot swallow pills, Benicar may be taken as a suspension.

Drug Interactions with Benicar

It is possible for Benicar to cause adverse reactions when taken concurrently with certain drugs (both prescription and nonprescription). These adverse reactions may include unfavorable side effects and/or decreased effectiveness of Benicar or the other drugs.

Drugs that Interact with Benicar

Aliskiren (Brand Name – Tekturna):

It is recommended that Benicar is not given in conjunction with aliskiren (antihypertensive drug) in patients with diabetes.

NonSteroidal Antiinflammatory Drugs (NSAID) including Selective COX-2 inhibitors:

Taking Benicar with NSAIDs, a type of pain medication including ibuprofen (Motrin) or naproxen (Aleve), can lead to decreased kidney function. Taking NSAIDs can also decrease the effects of Benicar.

Dual Blockade of the Renin-Angiotensin System (RAS):

Taking Benicar with other ARBs, ACE (angiotensin-converting enzyme) inhibitors (such as Captopril, Ramipril, Lisinopril, Quinapril and others) or aliskiren is associated with increased risks of low blood pressure, high potassium and changes in kidney function.

Colesevelam Hydrochloride (Brand Name – Welchol):

Taking colesevelam hydrochloride with Benicar reduces the effectiveness of Benicar. It is recommended that olmesartan is taken at least four hours prior to taking a dose of colesevelam hydrochloride in order to decrease the effect of the drugs’ interaction.

Mayo Clinic Study Confirms Olmesartan-Induced Enteropathy

Twenty-two patients who were seen at the Mayo Clinic between August 2008 and August 2011 were described in a study examining the link between olmesartan and unexplained sprue-like enteropathy. Olmesartan is an active ingredient in Benicar.

To be included in the study, patients had to have chronic diarrhea (lasting more than four weeks) while taking olmesartan. The cause of the symptoms could not be explained by another disorder, such as celiac disease; and finally, discontinuing the drug resulted in clinical improvement.

Mayo Clinic’s 2012 Report

In 2012, Mayo Clinic researchers published this study as a case series of sprue-like enteropathy associated with patients’ use of olmesartan.

2012 Results:

• The 22 subjects involved in the series presented similar clinical results to individuals of 23 adverse event reports identified by the FDA through its FDA’s Adverse Event Report System (FAERS).
• Of the 22 patients from 17 states treated by the Mayo Clinic between the years of 2008 to 2011, 14 required hospitalization with weight losses averaging almost 40 pounds, and one patient losing a total of about 125 pounds.
• None of the patients responded to gluten free diets (used for celiac disease sufferers).
• They were all taking daily doses of olmesartan ranging from 10 to 40 mg.
• When olmesartan was discontinued, the patients’ symptoms improved and they all experienced some degree of weight gain.

Mayo Clinic’s 2013 Report

In May 2013, an article was published describing patients with negative blood tests for celiac disease and villous atrophy, a condition in which the wall of the intestine erodes away.

2013 Results:

• The article reported that some patients without definitive causes for villous atrophy were categorized as having unclassified sprue.
• It was later discovered that some of these patients had villous atrophy associated with their use of olmesartan.

Olmesartan-induced enteropathy was further investigated using prescription refill information and Medicare insurance claims, which showed that patients using olmesartan had a higher rate of being diagnosed with celiac disease than users of other ARBs.

One 2022 clinical study noted the potential of olmesartan medoxomil nanoparticles delivered intranasally to improve the drug’s effectiveness. The engineered bioparticles showed a significant decrease in blood pressure and heart rate, suggesting the potential application of intranasal olmesartan medoxomil nanoparticles.

FDA-Initiated Label Change for Sprue-like Enteropathy

In 2013, the FDA issued a safety announcement about the potential for occurrences of sprue-like enteropathy. This decision came following its evaluation of FAERS, the Mayo Clinic case series and information from the Center for Medicare and Medicaid Services (CMS) database. The FDA also ordered the drug manufacturer to change its labeling on the blood pressure medication to include a warning about this.

In premarketing clinical trials, the incidence of adverse effects reported by Daiichi Sankyo related to olmesartan was similar to those of placebo, and the only negative effect linked directly to olmesartan with greater frequency than the placebo, as reported in the prescribing information, was dizziness. While millions of individuals have been prescribed olmesartan over the last several years, reports of severe gastrointestinal reactions associated with its use are claimed to not have surfaced until later in 2012.

Less than a year after the FDA ordered the label change for Benicar and other drugs containing olmesartan, patients who had suffered sprue-like enteropathy began filing Benicar lawsuits. Daiichi Sankyo, Benicar’s manufacturer, agreed in August 2017 to settle Benicar claims from about 2,300 plaintiffs in cases for $300 million.

In 2006, the U.S. Department of Health & Human Services (DOH) submitted a warning letter to Sankyo Pharma Inc. through its Division of Drug Marketing, Advertising and Communications (DDMAC). The letter requested that Sankyo immediately cease its promotion of certain sales and marketing materials that contained unsubstantiated effectiveness and superiority claims, and omitted or minimalized information on the risks associated with the use of Benicar.

Warning Letter to Benicar Manufacturer

In 2006, the U.S. Department of Health & Human Services (DOH) submitted a warning letter to Sankyo Pharma Inc. through its Division of Drug Marketing, Advertising and Communications (DDMAC). The letter requested that Sankyo immediately cease its promotion of certain sales and marketing materials that contained unsubstantiated effectiveness and superiority claims, and omitted or minimalized information on the risks associated with the use of Benicar.

The omitted or minimalized risk information included:

• Serious pregnancy-related risks
• Renal artery stenosis (narrowing of arteries that carry blood to one or both of the kidneys) precautions
• Risk information regarding the use of Benicar HCT in patients with impaired liver function or systemic lupus erythematosus (the most common form of lupus characterized by extreme fatigue and joint pain)
• Lithium interactions

In addition to the marketing warnings, Daiichi Sankyo faced kickback allegations. The U.S. Justice Department accused Daiichi Sankyo of paying doctors to prescribe Benicar. Daiichi Sankyo paid $39 million to settle the criminal case.

Benicar Facts

Please seek the advice of a medical professional before making health care decisions.

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Olmesartan (Benicar) for Hypertension | AAFP

KRISTINA E. WARD, PHARM.D., AND ANNE L. HUME, PHARM.D., B.C.P.S., University of Rhode Island College of Pharmacy, Kingston, Rhode Island

Am Fam Physician. 2005;72(4):673-674

Synopsis

Olmesartan (Benicar) is an angiotensin-II receptor blocker (ARB) labeled for the treatment of hypertension as monotherapy or in combination with other antihypertensive agents. Olmesartan blocks the binding of angiotensin II, a potent vasoconstrictor, to angiotensin type 1(AT₁) receptors located in vascular smooth muscle.¹

Safety

No serious safety issues were reported with olmesartan in clinical trials. The safety record of olmesartan was similar to placebo in seven randomized, double-blind, placebo-controlled phase II and III trials that included 2,540 patients with hypertension.² Adverse effects were reported in 42.2 percent and 42.7 percent of olmesartan-treated patients and placebo-treated patients, respectively. Olmesartan may cause hypotension and acute renal failure in patients who are sodium-or volume-depleted or whose renal perfusion is dependent on the renin-angiotensin system. Like all ARBs, olmesartan may precipitate acute renal failure in patients with renal artery stenosis. Significant hyperkalemia has not been reported with olmesartan, although it is possible, especially in patients with other risk factors for hyperkalemia. Of 3,825 patients treated with olmesartan during clinical trials, five reported angioedema.¹ It is not known whether patients who have developed angioedema with angiotensin-converting enzyme (ACE) inhibitors or other ARBs have an increased risk of developing this side effect with olmesartan. No dosage adjustments are needed in older patients or in patients with moderate to marked hepatic or renal impairment. As with other ARBs, olmesartan is U.S. Food and Drug Administration category C during the first trimester of pregnancy and category D during the second and third trimesters.¹ In rare instances, angioedema and rhabdomyolysis from olmesartan have been reported in postmarketing surveillance.¹

Tolerability

Olmesartan generally is well tolerated. In clinical trials, dizziness occurred in 2.8 percent of olmesartan-treated patients and in 0.9 percent of placebo-treated patients.² In a study³ comparing olmesartan to other ARBs, the incidence of dizziness was similar in olmesartan (1.4 percent), losartan (Cozaar; 0.7 percent), valsartan (Diovan; 1.4 percent), and irbesartan (Avapro; 3.4 percent). Headache was reported by 1.3 percent of patients receiving olmesartan and 2.5 percent receiving candesartan (Atacand).⁴ As with other ARBs, the incidence of cough with olmesartan is comparable to that with placebo (0. 9 and 0.7 percent, respectively).¹

Effectiveness

Short-term studies have shown that blood pressure control with olmesartan is similar to that achieved with other ARBs or amlodipine (Norvasc). Olmesartan in a dosage of 20 mg produces an average drop in diastolic blood pressure of 10 mm Hg and a comparable reduction in systolic blood pressure; this is in line with the reductions effected by equivalent dosages of other ARBs,^3,4 or a 5-mg dosage of amlodipine.⁵ Olmesartan has been studied in combination with hydrochlorothiazide (Esidrix) and has been found to produce an average additional diastolic blood pressure lowering of 7 to 10 mm Hg (with 20 mg or 40 mg olmesartan, respectively) compared with hydrochlorothiazide alone.⁶

Olmesartan has not been evaluated for the treatment of patients with heart failure or diabetic nephropathy. Although ARBs have been shown to decrease recurrent stroke in hypertensive patients,⁷ and mortality and morbidity in patients with hypertension accompanied by left ventricular hypertrophy,⁸ no studies have been performed to determine the effect of olmesartan on morbidity and mortality in patients with uncomplicated hypertension.

A one-month supply of Benicar in 20-mg tablets costs approximately $54, which is comparable to the price of other ARBs. Unlike other ARBs, however, the 5-mg, 20-mg, and 40-mg tablets of Benicar are similarly priced, which may be advantageous for self-paying patients.

Simplicity

The recommended starting dosage of olmesartan is 20 mg daily, taken with or without food. If blood pressure control is inadequate after two weeks, the dosage may be increased to a maximum of 40 mg daily. Dosages above 40 mg daily do not provide additional benefit. For patients who may be at risk for volume- or salt-depletion, such as those who have renal impairment and receive diuretics, a lower starting dosage is suggested. Olmesartan is available in 5-mg tablets if needed for dose reductions.

Bottom Line

Olmesartan is a safe and effective antihypertensive agent. There is no evidence that olmesartan is more effective than other ARBs or ACE inhibitors. The longest peer-reviewed studies of olmesartan are of two months’ duration; thus, there is no evidence showing olmesartan’s long-term benefit for cardiovascular or all-cause mortality. Because of its greater expense and lack of proven benefit over ACE inhibitors, olmesartan should be considered a second-line agent for hypertension except in patients who cannot tolerate ACE inhibitors.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, assistant medical editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

Antihypertensive drugs

In addition, ACE inhibitors, by reducing the conversion of angiotensin I to angiotensin II, lead to an increase in the content of angiotensin I in the blood and tissues.
The accumulation of angiotensin I contributes to its increased conversion into angiotensin-(1-7), which has a vasodilating and natriuretic effect.
Thus, the antihypertensive effect of ACE inhibitors is associated both with a decrease in the formation of vasoconstrictor substances (angiotensin II, as well as norepinephrine, arginine-vasopressin, endothelin-1), and with an increase in the formation or decrease in the breakdown of vasodilating substances (bradykinin, angiotensin-(1- 7), nitric oxide, prostaglandins).

A total of four ACE inhibitors (captopril, libenzapril, lisinopril and cenonapril) have direct biological activity.
All other known ACE inhibitors are themselves inactive substances, or prodrugs.
Only after absorption in the gastrointestinal tract, as a result of hydrolysis, they turn into active diacid metabolites, for example, enalapril turns into enalaprilat, fosinopril into fosinoprilat, etc.
Thus, all ACE inhibitors can be divided into two groups: 1) active dosage forms and 2) prodrugs.
Class 1 . Lipophilic drugs
• Captopril (Capoten)
Class II . Lipophilic prodiganism
• Subclass IIa – drugs with predominantly renal elimination (more than 60%): Benazepril (Lotenzin), Quinapril (Akkuper) Perindopril (Premino A, Hypernik, Perinprings, Prevent) Cylazapril (Inchibais, Caloside) Enalapril, Enalaprise, Zofenoprilay (Zofenoprilate, Zophenopril (zerois. Cardis )
• Subclass IIB – drugs with two main routes of elimination: moexipril (moex), ramipril (tritace, amprilan, chartil, dilaprel), fosinopril (monopril)
• Subclass IIC – drugs with predominantly hepatic elimination (more than 60%): spirapril (quadropril), trandolapril (hopten)
Class III . Hydrophilic preparations
Lisinopril (Irumed, Diroton, Dapril, Lysigamma, Sinopril) – a drug with high nephro- and cardioprotective properties
The most pronounced antihypertensive effect of ACE inhibitors is exerted on patients with increased activity of the renin-angiotensin-aldosterone system.
But ACE inhibitors cannot completely suppress the excess activity of the RAAS, because up to 70-80% of angiotensin II is synthesized in organs and tissues without the participation of ACE with the help of other enzymes (chymase, cathepsin, etc. ), and in the treatment of ACE inhibitors, the synthesis of angiotensin II can switch from the ACE-dependent pathway to the chymase pathway.
This explains the possibility of the phenomenon of “escape” of the antihypertensive effect in the treatment of ACE inhibitors, especially against the background of a high-salt diet, and serves as a rationale for the use of drugs that suppress the activity of angiotensin II, regardless of the route of its formation.

According to the duration of the antihypertensive effect, ACE inhibitors can be divided into three groups:

1. Short-acting drugs that must be administered 2 or 3 times a day (for example, captopril).
2. Intermediate-acting drugs that need to be taken at least twice a day (zofenopril and enalapril).
3. Long-acting drugs that in most cases provide round-the-clock control of blood pressure levels when taken once a day (quinapril, lisinopril, perindopril, ramipril, spirapril, trandolapril, fosinopril, etc. ).

ACE inhibitors are generally well tolerated by patients.
White men tolerate long-term ACE inhibitor therapy much better than white women, as well as blacks and Chinese.
• Side effects associated with the use of ACE inhibitors: specific and non-specific.

Specific
• Impaired renal function during treatment with ACE inhibitors is more common in patients with overt or latent kidney disease, including bilateral renal artery disease.
• Severe hyperkalemia (> 5.5 mEq/L) is uncommon with ACE inhibitors in patients with normal renal function (0%-6%).
• In addition to renal failure, concomitant use of potassium salts, potassium-sparing diuretics (amiloride, spironolactone, triamterene) and non-steroidal anti-inflammatory drugs (indomethacin, diclofenac, sulindac) are considered risk factors for the development of hyperkalemia in patients receiving ACE inhibitors.
• On the other hand, the combined use of loop and thiazide diuretics significantly reduces the risk of developing hyperkalemia during treatment with ACE inhibitors.
• Dry cough, according to the literature, occurs with an incidence of 1 to 48% during treatment with ACE inhibitors.
• The incidence of cough during treatment with ACE inhibitors is highly dependent on gender and race.
• For example, ACE inhibitor-associated cough is significantly more common in women than in men (approximately 7:3 ratio).
• Non-smokers have about twice the cough frequency as smokers.
• Perindopril and fosinopril have been observed to be less likely to cause dry cough than captopril, lisinopril and enalapril.
• Angioedema (Quincke’s edema) is also a common side effect of ACE inhibitors.
• It occurs much less frequently than dry cough – in 0.1-0.5% of cases, however, angioedema, unlike cough, can pose an immediate threat to the life of patients.
Non-specific side effects of ACE inhibitors include taste disturbances, leukopenia (neuropenia), skin rashes, dyspeptic disorders, as well as isolated cases of kidney and liver damage and anemia.

Contraindications
The use of ACE inhibitors as antihypertensive drugs is not recommended for bilateral renal artery stenosis, arterial stenosis of the only functioning kidney, severe renal failure (serum creatinine level above 300 µmol/l or 3.5 mg/dl), severe hyperkalemia (above 5.5 mmol / l), during pregnancy and in childhood, as well as with individual hypersensitivity to this group of drugs (dry cough or angioedema in history).

With great caution, ACE inhibitors should be used in patients with obliterating atherosclerosis of the arteries of the lower extremities (due to the frequent combination of atherosclerotic lesions of the peripheral and renal arteries), widespread atherosclerosis with lesions of the coronary and carotid arteries, moderate renal failure, moderate hyperkalemia (from 5 to 5.5 meq / l), chronic active hepatitis or cirrhosis of the liver, as well as in women of childbearing age (taking into account the possible adverse effects of drugs on intrauterine development of the fetus).

4. Angiotensin II receptor antagonists (AT1 receptor blockers)
In the action of AII on blood vessels, two mechanisms are distinguished – pressor and depressor.
The pressor mechanism is mediated by the influence of AII on type 1 receptors and leads to vasoconstriction, sodium and fluid retention, increased sympathetic activity, decreased vagal tone, cell proliferation, and a positive inotropic effect.
The depressant effect of AII is realized through stimulation of type 2 receptors, which leads to vasodilation, especially pronounced in the vessels of the brain and kidneys, natriuretic effect, antiproliferative effect, activation of kininogen, release of nitric oxide and prostaglandin I2.

A more effective and specific approach to inhibition of excessive activity of the renin-angiotensin system in HT is provided by a class of drugs – angiotensin II receptor blockers (ARBs) or AT1-angiotensin receptor blockers (sartans)
Sartans have a number of important advantages over ACE inhibitors
Bo- First, AT1-angiotensin receptor blockers are more effective than ACE inhibitors in suppressing the cardiovascular effects of activation of the renin-angiotensin system.
If ACE inhibitors act on only one of the pathways for the formation of angiotensin II, AT1-angiotensin receptor blockers act as angiotensin II antagonists, regardless of how angiotensin II was formed.
Therefore, AT1-angiotensin receptor blockers provide a more complete and more selective blockade of the renin-angiotensin system.

Secondly, the action of sartans is more specific than the action of ACE inhibitors.
Due to the lack of effect on the bradykinin-kallikrein-kinin system, the main distinguishing feature of ARBs was high safety and a small number of side effects comparable to placebo. The absence of cough and a negligible number of allergic reactions are the absolute advantages of sartans over ACE inhibitors.
The direct mechanism of the antihypertensive action of AT1-angiotensin receptor blockers is associated with a weakening of the effects of angiotensin II (and angiotensin III), which are mediated by AT1-angiotensin receptors.
In addition, blockade of angiotensin II receptors leads to a decrease in aldosterone secretion, a decrease in the reabsorption of sodium and water in the proximal segment of the renal tubules.
Sartans block only AT1 receptors while maintaining the ability of circulating AT II to interact with AT2 receptors, which is accompanied by vasodilation, antiproliferation and promotes additional organoprotective effects, and this, in turn, inhibits the progression of the disease.
By blocking AT1 receptors, AT1-angiotensin blockers reduce arterial vasoconstriction caused by angiotensin II (and angiotensin III), reduce increased hydraulic pressure in the renal glomeruli, and also reduce the secretion of aldosterone, arginine-vasopressin, endothelin-1 and norepinephrine.
With long-term use, AT1-angiotensin receptor blockers weaken the proliferative effects of angiotensin II on cardiomyocytes and smooth muscle cells of the vascular wall, as well as mesangial cells and fibroblasts.

• Losartan (Cozaar, Lorista, Lozap, Blocktran)
• Valsartan (Diovan, Valsakor, Valz)
• Irbesartan (Aprovel)
• Candesartan (Atakand) 900 03 • Eprosartan (Teveten)
• Telmisartan (Micardis)
• Olmesartan (benicar, cardosal)
• Azilsartan medoxomil (edarbi)
——————————- ——————–
• Prodrugs
Prodrugs include:
• Losartan – hepatic metabolism, only 14% converted to active metabolite,
• Candesartan, olmesartan and azilsartan – hydrolysis in the gastrointestinal tract.

Sartans have a large evidence base for cerebroprotection, nephroprotection and a reduction in the risk of cardiovascular complications.
A large number of controlled studies have shown their ability not only to slow down the rate of development and progression of target organ damage (decrease in left ventricular hypertrophy, decrease in the severity of microalbuminuria and proteinuria, slowing down the rate of decline in kidney function, cerebroprotection), but also to prevent organ damage.
• One of the important drug-specific aspects of the use of sartans is the reduction in the incidence of type 2 diabetes mellitus. 2010), high doses of losartan (RENAAL, 2001; RASS, 2009).
• For three drugs – losartan, valsartan and candesartan – CHF is registered as an indication for use.
At the same time, CHF is a contraindication for prescribing telmisartan
• In patients at high and very high risk of developing CVD, telmisartan is indicated even with high normal blood pressure. Among all ARBs, only telmisartan has been shown to reduce the incidence of all CV events with excellent treatment tolerance.
• Telmisartan has the longest half-life (more than 20 hours) of all sartans, which allows patients from the “non-dipper” group to move to the prognostically more favorable “dipper” group, with a minimal risk of increasing blood pressure in the early morning hours and a reduced risk of developing stroke.
• Telmisartan reduces LVH more effectively than other antihypertensive drugs
• Nephroprotection
• Reduces insulin resistance

Telmisartan not only improved anthropometric parameters, but also reduced the number and volume of body fat
When comparing Telmi sartans with other sartans have been shown to be beneficial in lowering triglyceride levels and increase in HDL level
Uricosuric effect
Decrease in RAAS and SNS activity

Azilsartan (Edarbi)
Experimental studies have shown that Edarbi® binds to angiotensin receptors more strongly than other ARBs (olmesartan, telmisartan, valsartan).
This explains the faster, longer and more pronounced antihypertensive effect of the drug
Olmesartan has not only good antihypertensive efficacy, the ability to reduce arterial stiffness, improve the function of the vascular endothelium, but also has cerebroprotective properties.
This allows us to recommend the drug primarily for the treatment of elderly patients with hypertension, for whom the task of maintaining cognitive functions is one of the priorities
In the olmesartan group, normalization of blood pressure was achieved in 75.4% of patients, in the treatment with perindopril – in 57.5%

5. α1-adrenergic receptor blockers
α-adrenergic receptor blockers represent a fairly large and heterogeneous group of drugs that have been used since the early 1960s to treat various forms of arterial hypertension.

Classification of α-adrenergic receptor blockers
α-Adrenergic receptor blockers are divided into two main groups:

1. non-selective and
2. α1-selective.

Non-selective (phentolamine) weaken the effects of catecholamines on both a1- and a2-adrenergic receptors, selective – selectively inhibit the effects of catecholamines on a1-adrenergic receptors of blood vessels and other organs and tissues.
• Prazosin – pratsiol, minipress, adverzuten,
• doxazosin – kamiren, cardura, tonocardin, artesin, doxaprostan)
• terazosin – cornam, setegis (BPH)
• tamsulosin – omnic (BPH)
hypertensive drugs that are not formally classified as group of a-blockers.
Thus, a1-adrenoblocking action was found in two b-blockers (carvedilol and proxodolol)

Extravascular effects of a1-blockers are of great clinical importance.
It has been established that selective blockers of a1-adrenergic receptors can improve the lipid composition of the blood – they significantly reduce the content of total cholesterol in the blood due to its atherogenic fraction – LDL cholesterol and at the same time increase HDL levels. The content of triglycerides also decreases during treatment with a1-blockers.
The effect of a1-blockers on blood lipid composition is especially pronounced in patients with atherogenic dyslipidemias

a1-blockers significantly increase the sensitivity of tissues to the action of insulin. Doxazosin, for example, causes a small but statistically significant decrease in basal glucose (by 7 mg/dl, or 5%) and insulin (by 14 mmol/l, or 17%) in hypertensive patients.
Two clinical studies have shown that a1-blockers (in particular, doxazosin) inhibit platelet aggregation

The predominance of a1-adrenergic receptors in the smooth muscles of the prostate and bladder neck served as the basis for the use of prazosin, and then other a1-blockers in patients with benign prostatic hyperplasia.

The tendency to orthostatic reactions, which is often found in the elderly and patients with diabetic neuropathy, is a contraindication for the use of a1-blockers.
By lowering blood pressure, a1-blockers cause reflex activation of the sympathetic nervous system, which is manifested by tachycardia.
Therefore, a1-blockers should not be used in patients with coronary artery disease with exertional angina without the simultaneous appointment of b-blockers, which prevent the occurrence of reflex tachycardia.

6. Central sympatholytics
Hyperactivity of the SNS is one of the main mechanisms for increasing blood pressure and a poor prognostic sign in patients with hypertension.
Approximately 30% of hypertensive patients have SNS hyperactivity, which is manifested not only by an increase in blood pressure, but also by tachycardia, increased cardiac output, renal vasoconstriction, fluid retention, and insulin resistance
reserpine
• 2nd generation – clonidine (clophelin, hemiton)
• 3rd generation (imidazoline receptor agonists) – moxonidine (cint, physiotens, moxogamma), rilmenidine (albarel)
According to modern concepts, the antihypertensive effect of moxonidine and rilmenidine is based on agonism against I1-imidazoline receptors of neurons located in the ventrolateral nuclei of the medulla oblongata.
By attenuating SNS hyperactivity, these I1-imidazoline receptor agonists reduce blood pressure and decrease heart rate.

Moxonidine reduces the activity of SNS and thus leads to a decrease in blood pressure.
An important advantage of moxonidine is a positive effect on carbohydrate and lipid metabolism. Moxonidine increases the sensitivity of tissues to insulin by improving the insulin-dependent mechanism of glucose transport into cells, reduces the level of insulin, leptin and glucose in the blood, reduces the content of triglycerides and free fatty acids, increases the level of HDL cholesterol.
In overweight patients, moxonidine results in weight loss (MERSY).
Moxonidine has an organoprotective effect: reduces LVH, improves diastolic function of the heart, cognitive functions of the brain, reduces MAU.
Moxonidine may be indicated for the treatment of hypertension in patients with MS or type 2 diabetes in combination with ACE inhibitors or ARBs, calcium antagonists.

Moxonidine and rilmenidine are contraindicated :
• severe mental depression,
• Sinus bradycardia (HR less than 50 per minute),
• Sick sinus syndrome,
• II-III degree atrioventricular block,
• Severe liver disease,
• Severe kidney failure.
Due to lack of clinical experience, it is recommended that moxonidine and rilmenidine should not be given to women during pregnancy and breastfeeding.

7. Renin inhibitors
Aliskiren (Rasilez) – direct renin inhibitor
Renin secretion by the kidneys and activation of the RAAS occurs with a decrease in BCC and renal blood flow through a feedback mechanism.
Renin acts on angiotensinogen, resulting in the formation of an inactive decapeptide – angiotensin I (ATI), which, with the help of ACE and, partially, without its participation, is converted into the active octapeptide angiotensin II (ATII).
ATII reduces renin secretion by a negative feedback mechanism. Drugs that inhibit the RAAS (including renin inhibitors) suppress negative feedback, leading to a compensatory increase in plasma renin concentration.

Treatment with ACE inhibitors and angiotensin II receptor antagonists also increases plasma renin activity, which is directly associated with an increased risk of cardiovascular disease in both patients with normal blood pressure and in patients with arterial hypertension.
When using aliskiren as a monotherapy and in combination with other antihypertensive agents, negative feedback suppression is neutralized, resulting in a decrease in plasma renin activity (in patients with arterial hypertension by an average of 50-80%), as well as ATI and ATII levels
In patients with arterial hypertension, when using Rasilez at a dose of 150 and 300 mg 1 time / day, there is a dose-dependent prolonged decrease in both systolic and diastolic blood pressure for 24 hours, including the early morning hours.
After 2 weeks of taking the drug, there is a decrease in blood pressure by 85-90% of the maximum, the hypotensive effect remains at the achieved level during long-term (up to 1 year) use.
After discontinuation of treatment with Rasilez, there is a gradual return of blood pressure to its original level within a few weeks, without the development of a withdrawal syndrome and an increase in plasma renin activity.
4 weeks after discontinuation of Rasilez, blood pressure remains significantly lower compared to placebo.

When using the drug for the first time, there is no hypotensive reaction (effect of the first dose) and a reflex increase in heart rate in response to vasodilation.
When using Rasilez as monotherapy and in combination with other antihypertensive drugs, an excessive decrease in blood pressure is observed in 0.1% and 1% of cases, respectively.
Combination therapy with Rasilez with ACE inhibitors, angiotensin II receptor antagonists, calcium channel blockers and diuretics is well tolerated by patients and allows to achieve an additional reduction in blood pressure.

Contraindications
• Severe renal dysfunction (serum creatinine >150 µmol/l for women and >177 µmol/l for men and/or glomerular filtration rate < 30 ml/min).
• Nephrotic syndrome.
• Renovascular hypertension.
• Regular hemodialysis.
• Severe hepatic impairment
• Children and adolescents under 18 years of age.
• Hypersensitivity to the components of the drug.
• With caution, the drug should be prescribed to patients with unilateral or bilateral renal artery stenosis or stenosis of the artery of a single kidney, diabetes mellitus, reduced BCC, hyponatremia, hyperkalemia, or patients after kidney transplantation. The safety of using Rasilez in patients with bilateral renal artery stenosis or stenosis of the artery of a single kidney has not been established.

Side effects
• Rasilez has been evaluated for safety in more than 7800 patients.
• When using the drug at a dose of up to 300 mg, the overall frequency of adverse reactions was similar to that when using placebo. Adverse reactions were generally mild, transient, and rarely required discontinuation of drug therapy. Diarrhea was most frequently observed in patients treated with Rasilez.
• When using the drug, there was no increase in the incidence of dry cough, characteristic of ACE inhibitors. The incidence of dry cough during treatment with Rasilez (0.9%) was similar to that of placebo (0.6%).
• From the digestive tract: often – diarrhea.
• Dermatological reactions: sometimes – skin rash.
• On the part of laboratory parameters: rarely – against the background of monotherapy, a slight decrease in the concentration of hemoglobin and hematocrit was observed (on average by 0.05 mmol / l and 0.16%, respectively), which did not require discontinuation of treatment (a decrease in the concentration of hemoglobin and hematocrit is also observed with the use of other drugs, affecting the RAAS, in particular ACE inhibitors and angiotensin II receptor antagonists), a slight increase in serum potassium concentration (0.9% compared to 0.6% when taking placebo).
• No clinically significant changes in total cholesterol, HDL, and fasting triglycerides, glucose, or uric acid were observed.
• Allergic reactions: in some cases – angioedema.

Combination therapy
• Use two drugs for initial therapy if BP is 20/10 mmHg above target. Art. (i.e. > 160/100 mmHg for patients with uncomplicated hypertension or > 150/90 mmHg Art. for people with diabetes and other comorbidities).
• Treatment of patients with grade 1 hypertension is often advisable to start with monotherapy.
• However, recent evidence suggests that the benefits of initial combination therapy may extend to patients with grade 1 hypertension.

Adverse events of antihypertensive drugs and ways to manage them

Top 5 best ACE inhibitors for effective treatment of hypertension

Contents

• 1 The best ACE inhibitors
  • 1.1 The concept of ACE inhibitors
  • 1.2 The occurrence of hypertension
  • 1.3 The action of ACE inhibitors
  • 1.4 Benefits of using ACE inhibitors
  • 1.5 Main indications for the use of ACE inhibitors
  • 1. 6 Top-5 of the best ACE inhibitors
  • 1.7 Ramipril
  • 1.8 Losartan
  • 1.9 Enalapril
  • 1.10 Related videos:
  • 1.11 Q&A:
    • • 1.11.0.1 What are the top 5 ACE inhibitors?
      • 1.11.0.2 How do ACE inhibitors work in the treatment of hypertension?

The best angiotensin converting enzyme (ACE) inhibitors will become an indispensable tool for the treatment of hypertension and cardiovascular diseases. Review the list of drugs that block ACE and provide effective blood pressure regulation and protection of organs from damage.

Hypertension is a serious disease that requires comprehensive and effective treatment. ACE inhibitors are one of the most effective treatments for high blood pressure. They help reduce blood pressure, improve heart function and prevent the development of complications.

Here are the top 5 best ACE inhibitors that can be used to effectively treat hypertension:

1. Enap is a powerful ACE inhibitor that has a long-lasting effect. It effectively lowers blood pressure and improves blood circulation. The drug has low toxicity and is well tolerated by patients.
2. Captopril is a drug that is actively used to treat hypertension. It reduces vascular resistance, improves heart function and prevents the development of cardiovascular complications.
3. Lisinopril – This ACE inhibitor has shown excellent results in the treatment of hypertension. It effectively lowers blood pressure, and also improves endothelial function and prevents the development of atherosclerosis.
4. Ramipril is a drug that allows you to achieve a stable reduction in blood pressure. It improves blood circulation, normalizes the work of the heart and prevents the development of left ventricular hypertrophy.
5. Perindopril – This ACE inhibitor is highly effective in the treatment of hypertension. It reduces blood pressure, improves kidney function and prevents the development of kidney failure.

The choice of an ACE inhibitor for the treatment of hypertension depends on the individual patient and the presence of comorbidities. Before you start taking any drug, be sure to consult your doctor.

Keep in mind that regular blood pressure monitoring and the use of recommended ACE inhibitors will help maintain cardiovascular health and prevent the complications of hypertension.

Understanding ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are a class of drugs used in the treatment of hypertension, heart failure, and other cardiovascular diseases. They work by blocking the action of ACE, which leads to a decrease in angiotensin II and vasodilation, which in turn reduces pressure in the blood vessels.

There are many ACE inhibitors, but some of the most effective and popular include lisinopril, enalapril, quinapril, ramipril, and perindopril. These drugs are well tolerated and safe, and studies show that they reduce the risk of developing cardiovascular complications.

When choosing an ACE inhibitor, the individual patient and the presence of comorbidities must be taken into account. It is important to consult with your doctor so that he prescribes the most suitable drug and the correct dosage.

Based on all the important information above, the general conclusion is that ACE inhibitors are effective drugs used to treat hypertension and other cardiovascular diseases. They have numerous benefits and are well tolerated by patients. If you have symptoms of hypertension or other related conditions, contact your doctor to learn more about ACE inhibitor treatment options.

The occurrence of hypertension

Hypertension, or high blood pressure, is one of the most common medical conditions in the world today. Its occurrence is associated with a number of factors, including genetic predisposition, unhealthy diet, sedentary lifestyle, excess weight and stress.

One effective treatment for hypertension is the use of angiotensin-converting enzyme (ACE) inhibitors. These drugs act on blood pressure regulation mechanisms by blocking the action of angiotensin-converting enzyme, which is involved in arterial narrowing.

Here is a list of the top five ACE inhibitors for effective treatment of hypertension:

1. Lisinopril: An effective and well-tolerated drug that lowers blood pressure and prevents organ damage.
2. Enalapril: has a pronounced antihypertensive effect, improves the contractile function of the heart and reduces the load on it.
3. Ramipril: has a pronounced cardioprotective effect, reduces the likelihood of developing cardiovascular complications.
4. Perindopril: improves microcirculation, reduces peripheral vascular resistance and exhibits cardioprotective and vasodilating effects.
5. Quinapril: effectively lowers blood pressure, slows the progression of left ventricular hypertrophy and prevents the development of cardiovascular complications.

Action of ACE inhibitors

ACE (angiotensin converting enzyme) inhibitors are a class of drugs used to effectively treat hypertension. They work by blocking the action of an enzyme that normally converts angiotensin I to angiotensin II. This reduces the contraction of blood vessels and the level of angiotensin II in the body, which leads to a decrease in blood pressure.

ACE inhibitors are one of the most effective treatments for hypertension and have several beneficial properties. First, they improve vascular function and reduce blood flow resistance, which helps lower blood pressure. In addition, ACE inhibitors may protect the kidneys by preventing glomerular damage and fluid retention in the body.

In general, ACE inhibitors are a powerful treatment for hypertension and can have positive effects on the heart, blood vessels, and kidneys. However, before starting the use of these drugs, it is necessary to consult a medical specialist and evaluate possible contraindications and side effects.

Benefits of using ACE inhibitors

Angiotensin converting enzyme (ACE) inhibitors are one of the most effective drug groups for treating hypertension. They have a positive effect on the cardiovascular system and have several advantages over other drug classes.

Low number of side effects

ACE inhibitors are well tolerated and rarely cause side effects. They do not adversely affect kidney function and do not cause drowsiness, nausea, or dizziness. This makes them an ideal choice for patients with unstable health or dental health problems.

Compatibility with other drugs

ACE inhibitors can be successfully combined with other drug groups such as diuretics or beta-blockers. This allows you to achieve the best control over blood pressure and reduce the risk of complications of hypertension.

Prevention of progression of left ventricular hypertrophy

Studies have shown that ACE inhibitors can slow or stop the progression of left ventricular hypertrophy. This condition is one of the major risk factors for developing heart failure, and preventing its progression plays an important role in the management of hypertension.

Kidney protection

ACE inhibitors have a protective effect on the renal vessels, which may reduce the risk of developing chronic renal failure. They help maintain normal blood flow to the kidneys and prevent damage to kidney structures.

Reducing the risk of myocardial infarction and stroke

ACE inhibitors reduce the risk of heart stroke and myocardial infarction in patients with hypertension. They reduce platelet aggregation and improve microcirculation, which helps to reduce the risk of blood clots and the development of cardiovascular complications.

Based on these benefits, ACE inhibitors are the best choice for treating hypertension and preventing its complications. They will help control blood pressure, protect target organs and improve the quality of life of patients.

Main indications for the use of ACE inhibitors

1. Hypertension: ACE inhibitors are one of the main drugs used to treat hypertension or high blood pressure. They help to reduce the contractile activity of blood vessels, improve blood circulation and reduce pressure on the walls of the arteries.

2. Chronic heart failure: ACE inhibitors are also commonly used to treat chronic heart failure. They reduce the load on the heart, improve its contractile function and prevent the development of complications.

3. Prevention of kidney damage: In patients with diabetes mellitus or chronic kidney disease, ACE inhibitors may be used to prevent kidney damage and slow the progression of the disease.

4. Stroke prevention: If risk factors for stroke such as high blood pressure or diabetes are present, ACE inhibitors may be recommended to prevent this serious complication.

5. Diabetic Nephropathy: ACE inhibitors may be used to treat diabetic nephropathy, a complication of diabetes that causes kidney damage. They can slow the progression of the disease and reduce the risk of major complications.

ACE inhibitors are reliable and effective drugs for the treatment of various conditions associated with high blood pressure and cardiovascular disease. However, before you start taking ACE inhibitors, you should consult your doctor and read the instructions for use.

Top 5 best ACE inhibitors

Hypertension or high blood pressure is a serious problem for many people. However, there is an effective way to control blood pressure and prevent the development of complications – the use of ACE inhibitors.

Among the many ACE inhibitors on the market, the top 5 most effective and safe drugs can be distinguished:

1. Losartan. This ACE inhibitor shows excellent results in lowering blood pressure and preventing the development of cardiovascular complications. It is also effective in treating kidney failure.
2. Enalapril. Is one of the most popular ACE inhibitors. It lowers blood pressure, improves heart function and reduces the risk of myocardial infarction and stroke.
3. Perindopril. Helps control blood pressure, prevents vascular damage and improves heart function.
4. Ramipril. An ACE inhibitor that effectively lowers blood pressure and prevents the development of cardiovascular complications.
5. Quinapril This drug not only lowers blood pressure, but also improves heart function, prevents complications and improves the patient’s quality of life.

It is important to understand that the choice of an ACE inhibitor should be made only on the advice of a physician, as each drug has its own characteristics and may not be suitable for a particular patient. However, the top 5 ACE inhibitors described above are reliable and time-tested drugs that can help control hypertension and prevent cardiovascular complications.

Ramipril

Ramipril is one of the most effective ACE inhibitors used to treat hypertension. The drug does an excellent job of normalizing blood pressure and improving heart function. It blocks the action of the angiotensin-converting enzyme, which leads to vasodilation and a decrease in blood flow resistance.

Ramipril has the advantage of being highly effective and well tolerated by the body. The drug not only lowers blood pressure, but also reduces the load on the heart, which is especially important for patients with heart failure. Ramipril prevents the progression of hypertension and reduces the risk of cardiovascular complications.

Ramipril is taken by mouth once a day. The dosage is prescribed by the doctor individually, based on the characteristics of the patient and the degree of hypertension. The drug is easily tolerated by the body, but it is necessary to follow the doctor’s recommendations for dosage and regularity of administration.

It is important to remember that ramipril is a drug and should only be used as directed by a physician. Reception must be carried out under constant medical supervision in order to achieve maximum efficiency and safety for the patient.

Losartan

Losartan is a highly effective ACE inhibitor that is widely used in the treatment of hypertension. Its mechanism of action is to block the action of angiotensin II, which is a powerful vasoconstrictor and blood pressure factor.

The advantages of losartan include its good tolerability and low incidence of side effects. In addition, losartan effectively lowers blood pressure both at rest and during exercise.

For greater ease of use, losartan is available in a variety of tablet strengths to allow the choice of the most suitable for each patient. Also, losartan can be used in combination with other drugs to achieve the best results in the treatment of hypertension.

It is important to note that losartan is a prescription drug and must be used under medical supervision. Failure to comply with recommendations on dosage and frequency of administration may lead to a decrease in the effectiveness of treatment and the occurrence of side effects.

So, losartan is one of the best ACE inhibitors for the effective treatment of hypertension. Its mechanism of action, high tolerability and convenient formulation make it an excellent choice for patients suffering from high blood pressure. However, before you start taking losartan, you should consult with your doctor.

Enalapril

Enalapril is one of the best ACE inhibitors for effective treatment of hypertension. It belongs to a class of drugs that help lower blood pressure and prevent the development of cardiovascular disease.

The active substance of the drug is enalapril, which is an angiotensin-converting enzyme (ACE) inhibitor. It is an important enzyme that plays a key role in the regulation of blood pressure. Enalapril blocks the action of ACE, which leads to vasodilation and a decrease in pressure.

The advantages of enalapril include its long duration of action and good patient tolerance. It effectively lowers blood pressure and improves heart function. Enalapril may also be given in combination with other antihypertensive drugs to achieve optimal pressure control.

It is important to note that enalapril is a drug and should only be taken with a doctor’s prescription. Taking the drug should be accompanied by regular monitoring of blood pressure and following the doctor’s recommendations. Talk to your doctor to learn more about using enalapril to treat your hypertension.

Related videos:

Q&A:

What are the top 5 ACE inhibitors?

The top 5 best ACE inhibitors for effective treatment of hypertension include the following drugs: lisinopril, enalapril, captopril, ramipril, perindopril.

How do ACE inhibitors work in the treatment of hypertension?

ACE inhibitors (angiotensin converting enzyme) help lower blood pressure by blocking the action of angiotensin II, which leads to vasodilation and decreased peripheral arterial resistance.