What is the role of telmisartan (Angiotensin II receptor antagonist) in managing atherosclerosis (hardening of the arteries) in patients with hypertension (high blood pressure)?

From the Guidelines

Telmisartan is recommended for the management of atherosclerosis in hypertensive patients due to its ability to control blood pressure and provide additional vascular protective effects, as evidenced by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1.

Key Points

• Telmisartan, an angiotensin II receptor blocker (ARB), is typically started at 40mg once daily and can be increased to 80mg daily if needed for optimal blood pressure control.
• Beyond blood pressure reduction, telmisartan offers unique benefits for atherosclerosis through its partial PPAR-gamma agonist activity, which improves insulin sensitivity, reduces inflammation, and helps prevent the progression of arterial plaque.
• The medication works by blocking the effects of angiotensin II, a hormone that causes blood vessel constriction and promotes inflammatory processes that contribute to atherosclerosis.
• Telmisartan should be taken consistently at the same time each day, usually in the morning, and patients should continue regular monitoring of blood pressure and periodic assessment of cardiovascular risk factors.

Benefits of Telmisartan

• Decreases oxidative stress in blood vessels
• Inhibits vascular smooth muscle cell proliferation
• Improves endothelial function
• Reduces the risk of major adverse cardiovascular events (MACE) in patients with peripheral artery disease (PAD) 1

Clinical Considerations

• The choice of antihypertensive medication should take into account the individual patient's characteristics, such as the presence of subclinical organ damage, clinical cardiovascular disease, renal disease, or diabetes.
• Telmisartan is a suitable option for patients with hypertension and atherosclerosis, particularly those with multiple cardiovascular risk factors.
• Regular monitoring of blood pressure and cardiovascular risk factors is essential to maximize the benefits of telmisartan therapy.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Role of Telmisartan in Managing Atherosclerosis

• Telmisartan, an Angiotensin II receptor antagonist, has been shown to have a positive effect on reducing cardiovascular morbidity and mortality in patients with hypertension 2.
• The ONTARGET trial demonstrated that telmisartan is as effective as ramipril in reducing cardiovascular risk in patients with atherothrombotic disease or diabetes with end-organ damage 2.
• Telmisartan has been found to reduce and stabilize atherosclerosis in ApoE and AT1aR double deficient mice, suggesting a protective effect on the development of atherosclerosis beyond AT1R blockade 3.

Mechanisms of Telmisartan in Atherosclerosis

• Telmisartan has a partial agonistic effect on peroxisome proliferator-activated receptor-gamma (PPAR-γ), which has been implicated in the regulation of atherosclerosis 3.
• Telmisartan decreases lipid deposition and increases collagen contents in plaques, indicating stabilization of plaques 3.
• Telmisartan also decreases macrophage accumulation and lipid deposition in plaques, suggesting an anti-inflammatory effect 3.

Clinical Evidence for Telmisartan in Atherosclerosis

• The STAR study found that telmisartan decreases total cholesterol levels in patients with hypertension, particularly in those with high cholesterol levels 4.
• Telmisartan has been shown to have a favorable effect on lipid and glucose metabolism, in addition to lowering blood pressure 4.
• The ONTARGET and TRANSCEND trials demonstrated the cardioprotective effects of telmisartan in high-risk patients 5.