Recommended Dose of Telmisartan for Adults with Hypertension
The recommended dose of telmisartan for adults with hypertension is 40 mg once daily as a starting dose, with a target dose of 80 mg once daily for optimal blood pressure control. 1
Dosing Guidelines
- The usual starting dose of telmisartan is 40 mg once daily 1
- Blood pressure response is dose-related over the range of 20 to 80 mg 1
- Most of the antihypertensive effect is apparent within 2 weeks and maximal reduction is generally attained after 4 weeks 1
- The target dose for optimal blood pressure control is 80 mg once daily 2
- For patients with heart failure with reduced ejection fraction (HFrEF), the target dose is 80 mg once daily, with 40 mg daily considered 50% of the target dose 2
Dosing Considerations
- No initial dosage adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis 1
- Patients on dialysis may develop orthostatic hypotension; their blood pressure should be closely monitored 1
- Telmisartan can be administered with or without food 1
- Telmisartan can be administered with other antihypertensive agents when combination therapy is needed 1
Efficacy and Pharmacokinetics
- At doses of ≥40 mg, telmisartan produces statistically significant reductions in blood pressure 3
- Telmisartan demonstrates a smooth, consistent blood pressure-lowering effect at 40 and 80 mg dosages with high trough-peak ratios 3
- The median time to maximum plasma concentration is 0.5-2 hours after oral dosing 4
- Telmisartan has a long terminal elimination half-life (>20 hours), making it suitable for once-daily dosing 4
- Steady state is observed after 5-7 days of once-daily administration 4
Treatment Strategy
- For patients with stage 1 hypertension (systolic BP 130-139 mmHg or diastolic BP 80-89 mmHg) and 10-year ASCVD risk ≥10%, initiation with a single antihypertensive drug is reasonable 2
- For patients with stage 2 hypertension (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) and BP more than 20/10 mmHg above target, initiation with 2 first-line agents of different classes is recommended 2
- Telmisartan can be used as monotherapy or in combination with other antihypertensive agents, particularly dihydropyridine calcium channel blockers or thiazide diuretics 2, 5
Special Populations
- In patients with chronic kidney disease and proteinuria, telmisartan has shown efficacy in reducing blood pressure and proteinuria 6
- For cardiovascular risk reduction in patients 55 years or older at high risk of developing major cardiovascular events who cannot take ACE inhibitors, the recommended dose is 80 mg once daily 1
Common Pitfalls and Caveats
- Avoid using telmisartan in pregnancy due to risk of fetal toxicity 1
- Do not co-administer aliskiren with telmisartan in patients with diabetes 1
- Do not combine telmisartan with ACE inhibitors or other ARBs as this combination is not recommended and potentially harmful 2
- In volume- or salt-depleted patients, symptomatic hypotension may occur after initiation; consider starting with a lower dose under close medical supervision 1
- Monitor for hyperkalemia, especially in patients with chronic kidney disease or those on potassium supplements or potassium-sparing drugs 2