What is the use of Telmisartan (Angiotensin II receptor antagonist)?

From the Guidelines

Telmisartan is an angiotensin II receptor blocker (ARB) medication primarily used to treat high blood pressure and reduce cardiovascular risk, particularly beneficial for patients with hypertension who also have diabetes or kidney disease, as it provides kidney protection. The typical starting dose is 40 mg once daily, which can be increased to a maximum of 80 mg daily if needed for blood pressure control. 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.

Key Points

• Telmisartan has a long half-life of about 24 hours, allowing for once-daily dosing, and it's generally well-tolerated with fewer side effects than some other blood pressure medications.
• Common side effects include dizziness, back pain, and sinus inflammation.
• It should not be used during pregnancy as it can harm the developing fetus.
• Patients should take telmisartan at the same time each day, with or without food, and should not stop taking it without consulting their healthcare provider, even if they feel well.
• According to the 2020 KDIGO clinical practice guideline 1, renin-angiotensin system (RAS) inhibitors, such as telmisartan, slow the progression of kidney disease in persons with albuminuria and hypertension independent of their effects on blood pressure.
• The guideline recommends that treatment with an angiotensin-converting enzyme inhibitor (ACEi) or an ARB be initiated in patients with diabetes, hypertension, and albuminuria, and that these medications be titrated to the highest approved dose that is tolerated 1.
• The ONTARGET trial compared telmisartan, ramipril, and combination therapy in patients with cardiovascular disease, including PAD, and/or diabetes mellitus, and found that all 3 treatments had similar cardiovascular event rates with higher rates of adverse events in the combination-therapy group 1.

From the FDA Drug Label

Telmisartan tablets, USP are indicated for reduction of the risk of myocardial infarction, stroke, or death from cardiovascular causes in patients 55 years of age or older at high risk of developing major cardiovascular events who are unable to take ACE inhibitors Telmisartan may be used alone or in combination with other antihypertensive agents The usual starting dose of telmisartan tablets is 40 mg once a day. Blood pressure response is dose-related over the range of 20 to 80 mg

The use of Telmisartan is for:

• Hypertension: to control high blood pressure
• Cardiovascular Risk Reduction: to reduce the risk of myocardial infarction, stroke, or death from cardiovascular causes in patients 55 years of age or older at high risk of developing major cardiovascular events who are unable to take ACE inhibitors 2

From the Research

Use of Telmisartan

• Telmisartan is an angiotensin II receptor antagonist used to treat hypertension and kidney diseases, including diabetic nephropathy 3, 4, 5, 6, 7.
• It has been shown to provide renal benefit at all stages of the renal continuum in patients with type 2 diabetes, improving endothelial function, delaying the progression to overt nephropathy, and reducing proteinuria 5.
• Telmisartan has been compared to other antihypertensive agents, such as enalapril, amlodipine, and atenolol, and has been found to be as effective in lowering blood pressure 6.
• The use of telmisartan has also been associated with a lower incidence of dry, persistent cough compared to lisinopril 6.
• In addition to its antihypertensive effects, telmisartan has been shown to attenuate diabetic nephropathy by suppressing oxidative stress in db/db mice 7.

Renoprotective Effects

• Telmisartan has been found to confer comparable renoprotection to enalapril in patients with type 2 diabetes, mild-to-moderate hypertension, and albuminuria 3.
• The long-term administration of high doses of telmisartan has been shown to improve the efficacy of the drug in decreasing proteinuria and slowing the progression to end-stage renal failure in nondiabetic hypertensive renal disease 4.
• Telmisartan has also been found to reduce albuminuria, mesangial matrix expansion, macrophage infiltration, and the expression of oxidative stress and inflammatory markers in renal tissue 7.

Therapeutic Options

• Telmisartan is a useful therapeutic option in the management of patients with hypertension, particularly those with diabetic nephropathy 5, 6.
• The addition of hydrochlorothiazide to telmisartan has been found to be more effective than each agent alone at lowering blood pressure in patients with hypertension 6.
• Telmisartan has been shown to be well tolerated in patients with mild to moderate hypertension, with a tolerability profile similar to that of placebo 6.