From the Guidelines
Telmisartan is recommended as a first-line treatment for patients with peripheral artery disease (PAD) and hypertension, due to its ability to reduce cardiovascular risk and improve outcomes, as shown in the ONTARGET trial 1. The use of telmisartan, an angiotensin II receptor blocker (ARB), is supported by recent guidelines and studies, which demonstrate its effectiveness in reducing the risk of major adverse cardiovascular events (MACE) in patients with PAD 1.
Key Points
- Telmisartan works by blocking the action of angiotensin II, a hormone that causes blood vessels to narrow, thereby allowing blood vessels to relax and widen, which lowers blood pressure.
- The typical starting dose of telmisartan is 40 mg once daily, which can be increased to a maximum of 80 mg daily if needed for blood pressure control.
- Patients should be aware that common side effects may include dizziness, back pain, and upper respiratory infections.
- Telmisartan is contraindicated during pregnancy as it can cause fetal harm.
- It's essential to monitor kidney function and potassium levels while taking this medication, especially in patients with kidney disease or those taking potassium supplements.
Benefits and Risks
The benefits of telmisartan in patients with PAD and hypertension include:
- Reduced risk of MACE, including stroke, MI, heart failure, and cardiovascular death 1.
- Improved insulin sensitivity and potentially reduced risk of new-onset diabetes compared to some other antihypertensive medications. However, it's crucial to consider the potential risks and contraindications, such as:
- Fetal harm during pregnancy.
- Increased risk of hypotension, syncope, and renal failure, particularly when used in combination with other medications 1.
Clinical Considerations
When prescribing telmisartan, clinicians should:
- Monitor blood pressure regularly to adjust the dose as needed.
- Assess kidney function and potassium levels regularly, especially in patients with kidney disease or those taking potassium supplements.
- Counsel patients on the potential side effects and risks associated with telmisartan. By considering the latest evidence and guidelines, clinicians can make informed decisions about the use of telmisartan in patients with PAD and hypertension, ultimately improving outcomes and reducing cardiovascular risk 1.
From the FDA Drug Label
Telmisartan tablets, USP are an angiotensin II receptor blocker (ARB) indicated for: Treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. ( 1.1) Cardiovascular (CV) risk reduction in patients unable to take ACE inhibitors ( 1.2)
The use of Telmisartan is for:
- Treatment of hypertension to lower blood pressure
- Cardiovascular risk reduction in patients who are unable to take ACE inhibitors 2, 2, 2
From the Research
Use of Telmisartan
Telmisartan is an angiotensin II receptor antagonist that is used to treat hypertension. The key uses of telmisartan include:
- Treatment of mild to moderate hypertension: Telmisartan has been shown to be effective in reducing blood pressure in patients with mild to moderate hypertension 3, 4.
- Treatment of severe hypertension: Telmisartan has been shown to be as effective as other antihypertensive agents, such as enalapril, in reducing blood pressure in patients with severe hypertension 3, 4.
- Cardiovascular risk reduction: Telmisartan has been shown to reduce cardiovascular risk in patients with high cardiovascular risk, including those with atherothrombotic disease, target organ damage associated with type 2 diabetes, and multiple risk factors 5, 6.
Efficacy and Tolerability
The efficacy and tolerability of telmisartan have been compared to other antihypertensive agents, including:
- Losartan: Telmisartan has been shown to be more effective than losartan in reducing blood pressure in some studies 3, 7.
- Amlodipine: Telmisartan has been shown to be as effective as amlodipine in reducing blood pressure in some studies 3, 4.
- Enalapril: Telmisartan has been shown to be as effective as enalapril in reducing blood pressure in some studies 3, 4.
- Ramipril: Telmisartan has been shown to be as effective as ramipril in reducing cardiovascular risk in patients with high cardiovascular risk 6.
Dosage and Administration
Telmisartan is typically administered once daily, with dosages ranging from 20 to 160 mg per day. The optimal dosage of telmisartan for a given patient will depend on a variety of factors, including the severity of their hypertension and their response to treatment 3, 4.