the novel pharmaceutical formulations of this invention comprise : a pharmaceutical carrier ; an ace inhibitor at the dose level normally employed in monotherapy , which is usually about 5 - 50 mg , depending on the ace inhibitor ; and a diuretic at a dose level which is the highest non - pharmacological dose . the formulation is designed for oral administration and is presented as tablets , capsules , gel caps , caplets or as a sustained release formulation . it may also be designed as an elixir for oral administration , or a suppository for rectal administration . illustrative of the excipients which can be incorporated in tablets , capsules and the like are : a binder such as gum tragacanth , acacia , corn starch or gelatin ; an excipient such as microcrystalline cellulose ; a disintegrating agent such as corn starch , pregelatinized starch , alginic acid and the like ; a lubricant such as magnesium stearate ; a sweetening agent such as sucrose , lactose or saccharin ; a flavoring agent such as peppermint , oil of wintergreen or cherry . when the unit dosage form is a capsule , it may contain , in addition to materials of the above type , a liquid carrier such as fatty oil . various other materials may be present as coatings or to otherwise modify the physical form of the dosage unit . for instance , tablets may be coated with shellac , sugar or both . a syrup or elixir may contain the active compound , sucrose as a sweetening agent , methyl and propyl parabens as preservatives , a dye and a flavoring such as cherry or orange flavor . the novel formulations of this invention are useful in the treatment of essential hypertension , and congestive heart failure . the ace inhibitors useful in the novel formulation and method of treatment of this invention are enalapril , lisinopril , captopril alacipril , benazapril , cilazapril , delapril , fosinopril , perindopril , quinapril , ramipril , moveltipril , spirapril , ceronapril , imidapril , temocapril , trandolopril , utilbapril , zofenopril , ( r )- 3 - ( s )- 1 - carboxy - 5 -( 4 - piperidyl ) pentyl ! amino - 4 - oxo - 2 , 3 , 4 , 5 - tetrahydro - 1 , 5 - benzothiazepine - 5 - acetic acid , libensapril , zalicipril , n - octyl 2 - n - ( s )- 1 - ethoxycarbonyl - 3 - phenylpropyl !- l - alanyl !-( 1s , 3s , 5s )- 2 - azabicyclo 3 , 3 , 0 ! octane - 3 - carboxylate maleate salt , 7 - ( s )- l - carboxy - 3 - phenylpropyl ) amino ! 4s - 4α , 7α ( r ), 12bβ ! !- 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 12b - octahydro - 6 - oxopyrido 2 , 1 - a ! 2 ! benzazepine - 4 - carboxylic acid , n - 8 - amino - 1 ( s )- carboxyoctyl !- l - alanyl - l - proline , 3 - pyridylcarbonyl - lys - α - d - glu - perhydroindole - 2 - carboxylic acid , benzhydryl 4α , 7α ( r ), 12bβ !- 7 - 1 -( ethoxycarbonyl ) phenylpropyl ! amino !- 1 , 2 , 3 , 4 , 6 , 7 , 12a , 12b - octahydro - 6 - oxopyrido 2 , 1 - a ! 2 ! benzazepine - 4 - carboxylate , 1 -( n -(( 1s )- 1 - carboxy - 3 - phenylpropyl )-( s )- alanyl - 4 -( n - methyl - n -( 6 - chloro - 7 - sulfamoyl )- 3 , 4 - dihydro - 1 , 2 , 4 - benzothiadiazine - 1 , 1 - dioxide - 3 - yl ) methyl ) aminoproline . preferred ace inhibitors are enalapril , lisinopril , captopril , perindopril , benzapril , quinapril , and cilazapril , especially enalapril . the diuretics useful in the novel formulation and method of treatment of this invention are : hydrochlorothiazide ( hctz ), furosemide , altizide , trichlormethazide , triflumethazide , bemetizide , cyclothiazide , methylchlothiazide , azosemide , chlorothiazide , butizide , bendroflumethazide , cyclopenthiazide , benzclortriazide , polythiazide , hydroflumethazide , benzthiazide , ethiazide , penflutazide . preferred diuretics for incorporation in the novel formulation of this invention are hydrochlorothiazide , trichlormethazide , furosemide and altizide , especially hydrochlorothiazide . in the specification and claims hereof , the naming of an ace inhibitor or diuretic such as enalapril or hydrochlorothiazide respectfully is meant to include salts thereof such as enalapril maleate . the novel method of treatment of this invention comprises the administration of a unit dose of the novel pharmaceutical formulation , one to three times a day depending on the patient and the severity of the indication being treated . usually once or twice a day is adequate . ______________________________________ amount ( mg ) component a b c______________________________________enalapril maleate 20 10 5hydrochlorothiazide 6 6 6sodium bicarbonate 10 5 2 . 5lactose 154 164 . 1 198 . 1starch nf 22 22 22 . 77pregelatinized starch nf 2 . 2 2 . 2 5 . 06magnesium stearate 1 . 1 1 . 0 0 . 90______________________________________ the excipients shown in example 1 are exemplary of the substituents used in each of the other examples that follow . ______________________________________ amount ( mg ) component 1 2 3______________________________________lisinopril 20 10 5hydrochlorothiazide 6 6 6______________________________________ ______________________________________ amount ( mg ) component 1 2 3______________________________________captopril 50 25 12 . 5hydrochlorothiazide 6 6 6______________________________________ ______________________________________ amount ( mg ) component 1 2 3______________________________________benazapril 40 20 10hydrochlorothiazide 6 6 6______________________________________ ______________________________________ amount ( mg ) component 1 2 3______________________________________quinapril 20 10 5hydrochlorothiazide 6 6 6______________________________________ ______________________________________ amount ( mg ) component 1 2 3______________________________________cilazapril 50 25 12 . 5hydrochlorothiazide 6 6 6______________________________________
pharmaceutical formulations comprising as active ingredients an angiotensin converting enzyme inhibitor at a dose level normally found effective as an antihypertensive and a diuretic at a dose level below its minimum effective dose , demonstrate greater efficacy than would be expected in returning the blood pressure of hypertensive patients to normotensive values .