enalapril + folic acid + hydrochlorothiazide

This is a fixed-dose combination drug containing three active ingredients: - **Enalapril** is an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, leading to vasodilation and reduced aldosterone secretion. - **Hydrochlorothiazide** is a thiazide diuretic that reduces blood pressure by increasing renal excretion of sodium and water through inhibition of the sodium-chloride symporter in the distal convoluted tubule. - **Folic acid** (vitamin B9) is included for its role in reducing homocysteine levels and may provide additional cardiovascular protection. Clinical studies have shown that combining enalapril with folic acid can further reduce the risk of first stroke in hypertensive patients compared to enalapril alone, especially in populations with low baseline folate[6][4]. The primary indication for this combination is hypertension, particularly where reduction of stroke risk or management of hyperuricemia or low folate status are also clinical considerations.