Blood Pressure Reduction with Telmisartan
Telmisartan reduces blood pressure by approximately 12-13/7-8 mmHg (systolic/diastolic) at the 80 mg dose, which is the target dose for maximum efficacy. 1
Dose-Response Relationship
The magnitude of blood pressure reduction varies by dose:
- 20 mg daily: Reduces BP by approximately 6-8/6 mmHg (SBP/DBP) 1
- 40 mg daily: Reduces BP by approximately 9-13/6-8 mmHg 1
- 80 mg daily: Reduces BP by approximately 12-13/7-8 mmHg 1
- Higher doses (up to 160 mg): Do not produce additional blood pressure reduction beyond 80 mg 1
Target Dosing for Maximum Efficacy
The American College of Cardiology recommends 80 mg once daily as the target dose for maximum blood pressure reduction and cardiovascular benefit. 2 This is also the FDA-approved maximum dose. 3
A common pitfall is settling for 40 mg as maintenance therapy—the dose-response relationship clearly demonstrates additional benefit at 80 mg, and clinical trials consistently show higher doses provide greater benefits. 2
Time Course of Blood Pressure Reduction
- Onset: Blood pressure reduction begins within 3 hours after the first dose 1
- Maximum effect: Achieved by approximately 4 weeks of treatment 1
- Duration: Antihypertensive effect is maintained for the full 24-hour dosing interval 1
- Trough-to-peak ratio: 70-100% for both systolic and diastolic BP at 40-80 mg doses 1
Real-World Clinical Trial Data
In clinical studies of patients with mild to moderate hypertension:
- Mean BP reduction of 14.4/10.3 mmHg after 12 weeks at doses of 40-80 mg daily 4
- In patients with chronic kidney disease and proteinuria, telmisartan reduced office BP by 19.6/11.8 mmHg over 6 months (when added to existing therapy and titrated to 80 mg) 5
- Ambulatory blood pressure monitoring confirms sustained reduction during the last 6 hours of the dosing interval (18-24 hours post-dose), with reductions of approximately 8/5 mmHg 4
Clinical Context for Blood Pressure Goals
The WHO and ACC/AHA recommend:
- General hypertension: Target <140/90 mmHg 6
- Known cardiovascular disease: Target systolic <130 mmHg 6, 3
- High-risk patients (diabetes, CKD, high CV risk): Consider systolic target <130 mmHg 6, 3
Most patients require combination therapy to achieve these targets—two or more antihypertensive medications are needed in the majority of cases. 6 If BP remains uncontrolled on telmisartan 80 mg, add a thiazide diuretic or calcium channel blocker rather than exceeding the maximum dose. 3, 7