Recommended Dosing of Telmisartan for Hypertension
The recommended dose of telmisartan for treating hypertension is 40 mg once daily initially, which can be titrated up to 80 mg once daily for optimal blood pressure control. 1
Initial Dosing and Titration
- The usual starting dose 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, with maximal reduction generally attained after 4 weeks 1
- If blood pressure control is not adequate with 40 mg, the dose can be increased to 80 mg once daily 2, 3
Dosage Considerations
- No initial dosage adjustment is necessary for elderly patients 1
- No dosage adjustment is required for patients with renal impairment, including those on hemodialysis 1
- Patients on dialysis may develop orthostatic hypotension and should have their blood pressure closely monitored 1
- Telmisartan can be administered with or without food 1
Maximum Dose
- The maximum recommended dose is 80 mg once daily 2, 3
- Clinical studies have shown that doses higher than 80 mg do not provide significant additional blood pressure reduction 4
Combination Therapy
- Telmisartan may be administered with other antihypertensive agents if needed for blood pressure control 1
- The addition of hydrochlorothiazide to telmisartan has been shown to be more effective than either agent alone 4
Special Considerations
- Monitor for hypotension in volume- or salt-depleted patients 1
- Do not use telmisartan in combination with ACE inhibitors or direct renin inhibitors due to increased risk of adverse effects 2, 3
- Monitor for hyperkalemia, especially in patients with chronic kidney disease or those on potassium supplements or potassium-sparing drugs 2, 3
- Telmisartan is contraindicated during pregnancy 3, 1
Clinical Efficacy
- Telmisartan 80 mg has been shown to be more effective than submaximal doses of losartan (50 mg) or valsartan (80 mg) in controlling blood pressure throughout the 24-hour dosing interval 4, 5
- Telmisartan provides superior blood pressure control in the early morning hours compared to several other antihypertensive medications 5
- In comparative studies, telmisartan 40-80 mg was as effective as atenolol 50-100 mg and lisinopril 10-40 mg in reducing blood pressure 4, 6
Cardiovascular Risk Reduction
- For cardiovascular risk reduction in patients 55 years or older at high risk of developing major cardiovascular events, the recommended dose is 80 mg once daily 1