Hydrochlorothiazide vs. Benazepril

See how Hydrochlorothiazide and Benazepril compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Hydrochlorothiazide is a diuretic that lowers blood pressure by removing excess fluid, while benazepril is an ACE inhibitor that relaxes blood vessels directly.

  • Doctors often prescribe these two drugs together because they work through different mechanisms and can lower blood pressure more than either alone.

  • Benazepril carries a boxed warning for fetal harm, and hydrochlorothiazide is also not recommended during pregnancy, so both need alternatives if pregnancy occurs.

Hydrochlorothiazide vs. Benazepril Drug Summary

Hydrochlorothiazide

Hydrochlorothiazide is a thiazide diuretic used to lower blood pressure and reduce fluid buildup from conditions like heart failure or kidney disease. It works by helping the kidneys remove excess salt and water through urine. It comes as a tablet or capsule taken once daily, often alongside other blood pressure medications.

Benazepril

Benazepril is an ACE inhibitor used to lower blood pressure in adults and children six and older. It works by blocking an enzyme that narrows blood vessels, allowing them to relax and blood pressure to drop. It comes as a tablet taken once daily, with the dose adjusted based on response.

Hydrochlorothiazide vs. Benazepril Side Effects

Hydrochlorothiazide

Most common
Weakness (not specified)
Hypotension (not specified)
Hypokalemia (not specified)
Hyperglycemia (not specified)

Benazepril

Most common
Headache (up to 6%)
Dizziness (up to 4%)
Somnolence (up to 2%)
Postural dizziness (up to 2%)

Hydrochlorothiazide vs. Benazepril Dosage

Hydrochlorothiazide

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25 mg once daily At the start
Maximum dose 25-100 mg once daily If needed
Dose changes 2 increases As tolerated

Benazepril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg once daily At the start
Maximum dose 0.6 mg/kg once daily If needed
Dose changes 6 increases As tolerated

Hydrochlorothiazide vs. Benazepril Indications

Hydrochlorothiazide

Hydrochlorothiazide is FDA-approved to treat high blood pressure, either alone or with other medications, and to reduce fluid buildup from heart failure, liver disease, kidney problems, or steroid and estrogen use. It is also used off-label to help prevent calcium-based kidney stones. It has been prescribed for over 60 years and is often combined with other diuretics or blood pressure drugs.

  • Hypertension, alone or with other antihypertensives

  • Edema from heart failure, cirrhosis, or kidney disease

  • Edema from corticosteroid or estrogen therapy

Benazepril

Benazepril is FDA-approved only for lowering blood pressure in adults and children age six and older. It is not approved to treat fluid retention or other conditions the way some other blood pressure drugs are. It is often used with a diuretic like hydrochlorothiazide for added blood pressure control.

  • Hypertension in adults

  • Hypertension in children age six and older

  • Often combined with a diuretic for added effect

Hydrochlorothiazide vs. Benazepril Pros and Cons

Hydrochlorothiazide

Hydrochlorothiazide has been used for more than 60 years and is one of the most affordable blood pressure medications available. It also treats fluid retention from heart failure, liver, and kidney disease, not just hypertension. It requires periodic blood testing to monitor electrolytes and kidney function.

Pros

  • Also treats fluid retention, not just high blood pressure

  • Decades of real-world safety data

  • Often combined with other antihypertensives in one pill

  • No boxed warning on its label

Cons

  • Can cause electrolyte imbalances needing monitoring

  • Linked to increased skin cancer risk with long-term use

  • Only lowers blood pressure indirectly through fluid loss

  • Not recommended during pregnancy

Benazepril

Benazepril belongs to a class of drugs, ACE inhibitors, thought to offer added protection to the kidneys and heart beyond blood pressure lowering alone. It is approved for children as young as six with weight-based dosing. Like other ACE inhibitors, it carries a boxed warning for serious harm to a developing fetus.

Pros

  • May offer added kidney and heart protection beyond BP control

  • Approved for pediatric use with weight-based dosing

  • Multiple dose strengths allow fine titration

  • Lower risk of electrolyte depletion than diuretics

Cons

  • Boxed warning for fetal toxicity during pregnancy

  • Can cause angioedema, including rare fatal reactions

  • Less effective as a standalone drug in Black patients

  • Cough can lead some patients to stop treatment

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