Recommended Dosing of Telmisartan for Hypertension
The recommended daily dose of telmisartan for hypertension is 40 mg once daily initially, with titration up to 80 mg once daily if needed for blood pressure control. 1
Initial Dosing
- The usual starting dose is 40 mg once daily 1
- For patients who may need additional blood pressure reduction, the dose can be increased to 80 mg once daily 1
- No initial dosage adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis 1
- Most of the antihypertensive effect becomes apparent within 2 weeks of starting treatment 1
- Maximal blood pressure reduction is generally attained after 4 weeks of treatment 1
Dose Range and Response
- Blood pressure response is dose-related over the range of 20 to 80 mg 1
- At doses of ≥40 mg, telmisartan produces statistically significant reductions in blood pressure 2
- Maximum blood pressure reduction typically occurs with a dosage of 40 to 80 mg/day 3
- The 40 mg and 80 mg doses demonstrate smooth, consistent blood pressure-lowering effects with high trough-peak ratios 2
Administration Considerations
- Telmisartan may be administered with or without food 1
- It can be administered with other antihypertensive agents when combination therapy is needed 1
- For stage 2 hypertension (BP ≥140/90 mmHg with BP more than 20/10 mmHg above target), initiation with combination therapy including telmisartan may be appropriate 4
Monitoring
- Blood pressure should be monitored regularly during dose titration 4
- Patients on dialysis may develop orthostatic hypotension and should have their blood pressure closely monitored 1
- Follow-up evaluation of adherence and response to treatment should occur at monthly intervals until control is achieved 4
Special Considerations
- For cardiovascular risk reduction in high-risk patients 55 years or older, the recommended dose is 80 mg once daily 1
- Telmisartan demonstrates superior antihypertensive effect toward the end of the dosing interval compared with some other agents like amlodipine and losartan 2
- Telmisartan has a long terminal elimination half-life (>20 hours), making it suitable for once-daily dosing 5
Common Pitfalls to Avoid
- Underdosing: Some patients may remain on suboptimal doses, which could result in inadequate blood pressure control 3
- Inadequate monitoring: Failure to monitor blood pressure response may lead to suboptimal treatment outcomes 4
- In patients with an activated renin-angiotensin system (e.g., volume or salt-depleted patients), symptomatic hypotension may occur after initiation of therapy 1