Impaired fibrinolysis is associated with thromboembolic complications in hypertensive patients. Cardiovascular morbidity/mortality rates have been reported high even after lowering the elevated blood pressure with anti hypertensive drugs. We investigated the effects of clinically used dosages of cilazapril on the fibrinolytic system in hypertensive patients. The present study was performed among 30 hypertensive patients (22 women, eight men), who received 2.5 - 5.0mg cilazapril daily for 1 month. Before and after the cilazapril treatment, patients' venous blood was drawn for fibrinolytic tests. The fibrinolytic activity was examined utilizing the euglobulin clot lysis time and fibrin plate methods. Using the fibrin plate method, as compared with the pretreatment group, we observed a 57% increased activity in the hypertensive patients receiving cilazapril (P < 0.001). When assessed by the euglobulin clot lysis time method, the activity due to cilazapril treatment was found to be relatively low, although highly significant (similar to 20%, P < 0.001). Changes in fibrinolytic activity were observed in 23 (77%) hypertensive patients after cilazapril treatment; however, their blood pressure remained normal. The remaining seven patients' (23%) blood pressures and fibrinolytic activity did not change significantly after cilazapril treatment. In conclusion, we suggest that the observed differential fibrinolytic activity between the pre and post cilazapril treatment values is due to the plasminogen activators released from the vascular endothelium, which may have been stimulated by cilazapril. It appears that cilazapril is not only an angiotensin-converting enzyme inhibitor but also a stimulator for fibrinolytic activity, which may be an added component in reducing thromboembolic complications in hypertensive patients.