Which of the following ACE inhibitors has a 50% renal and 50% hepatic elimination?

Fosinopril is the ACE inhibitor that is eliminated equally through both renal and hepatic pathways. This unique characteristic makes it particularly useful in patients with varying degrees of renal function, as its elimination is not solely dependent on the kidneys. In cases where renal function is compromised, the hepatic elimination allows for more stable drug levels and potentially reduces the risk of accumulation, which might occur with other ACE inhibitors that are primarily eliminated renally.

In contrast, lisinopril, perindopril, and quinapril predominantly undergo renal elimination. This means that in patients with impaired renal function, these medications may require careful dosing or may not be the best choice due to the higher risk of side effects related to elevated drug levels. Thus, fosinopril stands out as the most balanced option, making it conducive for managing conditions in a wide range of patients.