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dog canine hypertension pharmacology antihypertensive drugs treatment 2025

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dog antihypertensive drugs doses ACE inhibitor amlodipine telmisartan

Here is a comprehensive overview of antihypertensive pharmacology in dogs, based on the ACVIM Consensus Guidelines (PMC6271319) and current veterinary practice:

Canine Hypertension — BP Pharmacology

Classification of Hypertension (ACVIM)

Category	SBP (mm Hg)	Risk
Normotensive	< 140	Minimal
Pre-hypertensive	140–159	Low
Hypertensive	160–179	Moderate
Severely hypertensive	≥ 180	High

Key point: >80% of canine hypertension is secondary — identify and treat the underlying cause (CKD, hyperadrenocorticism, pheochromocytoma, hypothyroidism, diabetes) alongside antihypertensive therapy.

Drug Classes & Doses

1. RAAS Inhibitors (First-Line in Dogs)

Preferred due to antiproteinuric effects and renal protection. They dilate the efferent arteriole, reducing intraglomerular pressure.

Drug	Class	Dose
Enalapril	ACE inhibitor	0.5–2.0 mg/kg PO q12h
Benazepril	ACE inhibitor	0.5 mg/kg PO q12–24h
Telmisartan	ARB	1.0 mg/kg PO q24h

ACEi (enalapril/benazepril) are the standard initial choice in most hypertensive dogs
Telmisartan (ARB) is an alternative, especially if ACEi is not tolerated
Target: reduce UPC ratio by ≥50%, ideally to <0.5 in CKD dogs

2. Calcium Channel Blockers (CCB)

Amlodipine — dihydropyridine CCB, dilates afferent arteriole

Drug	Dose
Amlodipine	0.1–0.5 mg/kg PO q24h

Caution: CCB monotherapy in dogs should be avoided — afferent dilation alone increases glomerular capillary pressure, potentially worsening renal disease. Combination RAAS + CCB is appropriate for dogs with SBP >200 mm Hg, as RAAS inhibitors counterbalance afferent dilation by dilating the efferent arteriole.

3. α₁-Blockers

Used in pheochromocytoma or refractory cases.

Drug	Dose
Prazosin	0.5–2 mg/kg PO q8–12h
Phenoxybenzamine	0.25 mg/kg PO q8–12h or 0.5 mg/kg q24h

4. Direct Vasodilators

Drug	Dose	Notes
Hydralazine	0.5–2 mg/kg PO q12h	Start low; used for refractory/emergency cases

5. Diuretics (adjunctive)

Drug	Dose
Hydrochlorothiazide	2–4 mg/kg PO q12–24h
Furosemide	1–4 mg/kg PO q8–24h
Spironolactone	1–2 mg/kg PO q12h

6. Beta-Blockers

Drug	Dose	Notes
Atenolol	0.25–1 mg/kg PO q12h	Rarely first-line for hypertension alone
Propranolol	0.2–1 mg/kg PO q8h	Non-selective; use with caution

7. Emergency / Parenteral Options (Hypertensive Crisis)

Drug	Mechanism	Notes
Fenoldopam	Dopamine D1 agonist	Causes renal artery dilation + natriuresis; safe in dogs
Hydralazine	Direct vasodilator	IV use in crisis
Labetalol	α/β-blocker	IV available
Nitroprusside	NO donor	IV; potent; intensive monitoring required

Treatment Algorithm

SBP 160–179 mmHg (moderate risk)
  → ACE inhibitor (enalapril or benazepril 0.5–2 mg/kg PO q12h)
  → Recheck in 1–3 weeks

SBP ≥ 180 mmHg (high/severe risk) OR active TOD
  → Amlodipine 0.625 mg PO q24h OR Telmisartan 1.5 mg/kg PO q12–24h
  → Consider RAAS + CCB combination

SBP > 200 mmHg
  → Start RAAS inhibitor + amlodipine simultaneously

Target Organ Damage (TOD) to Assess

Eyes: hypertensive retinopathy, retinal detachment
Kidneys: proteinuria, CKD progression
Cardiovascular: LV hypertrophy, aortic dilation
CNS: seizures, vestibular signs, behavioral changes

Monitoring

Recheck BP 2–3 times over 1–2 weeks after starting/changing therapy
Once stable: BP monitoring every 3–6 months
Monitor renal function (creatinine, SDMA, UPC) — especially with ACEi/ARBs
Amlodipine can improve SDMA in dogs with CKD (Frontiers Vet Sci, 2025)

Drugs That Can Cause Hypertension in Dogs (Secondary)

Glucocorticoids
Mineralocorticoids
Phenylpropanolamine (PPA) — at high doses
Ephedrine
Topical ocular phenylephrine

Source: ACVIM Consensus Guidelines — Hypertension in Dogs & Cats | Today's Veterinary Practice Algorithm 2025

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