Maximum Dose of Telmisartan for Adults with Hypertension
The maximum recommended dose of telmisartan for adults with hypertension is 80 mg once daily. 1
Dosing Information
- The usual starting dose of telmisartan is 40 mg once daily 1
- Dosage range for hypertension is 20-80 mg once daily, with most of the antihypertensive effect apparent within 2 weeks and maximal reduction generally attained after 4 weeks 1
- Maximum blood pressure reduction occurs with dosages of 40 to 80 mg/day 2
- No initial dosage adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis 1
Efficacy Considerations
- At doses of ≥40 mg, telmisartan produces statistically significant reduction in blood pressure 3
- Telmisartan 80 mg/day has been shown to be more effective than submaximal dosages of losartan (50 mg/day) or valsartan (80 mg/day) 2
- Ambulatory blood pressure monitoring demonstrates smooth, consistent blood pressure-lowering effects at 40 and 80 mg dosages 3
- Telmisartan demonstrates superior antihypertensive effect toward the end of the dosing interval compared with amlodipine and losartan 3
Administration Considerations
- Telmisartan may be administered with or without food 1
- It can be administered with other antihypertensive agents when needed for blood pressure control 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 recommended 4
- If blood pressure remains uncontrolled on maximum dose (80 mg), add a second antihypertensive agent from a different class (preferably a thiazide diuretic or calcium channel blocker) 4
Clinical Pearls and Cautions
- Telmisartan has a long terminal elimination half-life (>20 hours), making it suitable for once-daily dosing 5
- Like other angiotensin receptor blockers (ARBs), telmisartan is contraindicated during pregnancy due to potential fetal harm 6
- Patients on dialysis may develop orthostatic hypotension; their blood pressure should be closely monitored 1
- Telmisartan has a side-effect profile comparable to that of placebo in clinical trials 3, 2
Remember that blood pressure should be monitored regularly during dose titration, with follow-up evaluation of adherence and response to treatment at monthly intervals until control is achieved 4.