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
Benazepril
Hydrochlorothiazide vs. Benazepril Dosage
Hydrochlorothiazide
Benazepril
| 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 |
| 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
| 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
| 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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