What is the recommended dosage and use of Telmisartan (angiotensin II receptor antagonist) for treating hypertension?

Telmisartan Dosing for Hypertension

The recommended starting dose of telmisartan for hypertension is 40 mg once daily, with a dose range of 20-80 mg, and most patients achieve maximal blood pressure reduction after 4 weeks of treatment. 1

Dosing Recommendations

• The usual starting dose is 40 mg once daily, with blood pressure response being dose-related over the range of 20-80 mg 1
• Most of the antihypertensive effect becomes apparent within 2 weeks, with maximal reduction generally attained after 4 weeks 1
• For patients requiring greater blood pressure reduction, the dose can be increased to 80 mg once daily 1, 2
• Telmisartan may be administered with or without food 1
• No initial dosage adjustment is necessary for elderly patients or those with renal impairment, including patients on hemodialysis 1

Efficacy and Monitoring

• At doses of ≥40 mg, telmisartan produces statistically significant reductions in blood pressure 2
• Blood pressure should be monitored regularly during dose titration as recommended by the American College of Cardiology and American Heart Association 3
• Follow-up evaluation of adherence and response to treatment should occur monthly until blood pressure control is achieved 3
• Patients on dialysis may develop orthostatic hypotension and should have their blood pressure closely monitored 1

Treatment Algorithm

• For stage 1 hypertension: Start with telmisartan 40 mg once daily 1
• For stage 2 hypertension (BP ≥140/90 mmHg with BP more than 20/10 mmHg above target): Consider initial combination therapy with telmisartan plus another agent (preferably a thiazide diuretic or calcium channel blocker) 3
• If blood pressure remains uncontrolled on maximum telmisartan dose (80 mg), add a second antihypertensive agent from a different class 3
• Telmisartan may be administered with other antihypertensive agents when needed for blood pressure control 1

Cardiovascular Risk Reduction

• For cardiovascular risk reduction in patients 55 years or older at high risk of major cardiovascular events who cannot take ACE inhibitors, the recommended dose is 80 mg once daily 1
• When initiating telmisartan for cardiovascular risk reduction, blood pressure should be monitored and other blood pressure medications adjusted if appropriate 1

Clinical Considerations and Cautions

• Telmisartan has been shown to be as effective as other major classes of antihypertensive agents at lowering blood pressure 4
• Compared to other ARBs like losartan, telmisartan 80 mg demonstrates superior blood pressure control, particularly toward the end of the dosing interval 2, 5
• Telmisartan has a tolerability profile similar to placebo in clinical studies 2, 6
• Avoid combining telmisartan with ACE inhibitors or direct renin inhibitors 1
• Telmisartan is contraindicated in patients with known hypersensitivity to the drug 1
• Do not co-administer aliskiren with telmisartan in patients with diabetes 1
• Telmisartan is contraindicated during pregnancy, particularly in the second and third trimesters 1

Special Populations

• In patients with hypertension and chronic kidney disease, telmisartan has shown efficacy in reducing both blood pressure and proteinuria 7
• For patients with severe hypertension, telmisartan 80-160 mg/day has demonstrated effectiveness comparable to enalapril-based regimens 4