What is the usual and maximum dosing of telmisartan (angiotensin II receptor antagonist) for adults with hypertension (high blood pressure) and heart failure?

Telmisartan Dosing for Adults

For hypertension, start telmisartan at 40 mg once daily with a maximum dose of 80 mg once daily; for cardiovascular risk reduction, use 80 mg once daily. 1

Standard Hypertension Dosing

• Usual starting dose: 40 mg once daily 1
• Dose range: 20-80 mg once daily 1
• Maximum dose: 80 mg once daily 1

The blood pressure response is dose-related across the 20-80 mg range, with most antihypertensive effect apparent within 2 weeks and maximal reduction generally attained after 4 weeks 1. Maximum blood pressure reduction occurs with dosages of 40-80 mg daily 2.

Cardiovascular Risk Reduction Dosing

• Recommended dose: 80 mg once daily 1
• This indication applies to patients ≥55 years at high cardiovascular risk who cannot take ACE inhibitors 1
• Doses lower than 80 mg have not been shown effective for cardiovascular risk reduction 1

Target Dosing for Heart Failure

• Target dose: 80 mg once daily (considered the optimal dose for guideline-directed medical therapy) 3
• 40 mg daily represents 50% of the target dose for patients with heart failure with reduced ejection fraction 3

Administration Considerations

• No initial dose adjustment needed for elderly patients or those with renal impairment, including hemodialysis patients 1
• Can be administered with or without food 1
• May be used alone or combined with other antihypertensive agents, particularly thiazide diuretics or dihydropyridine calcium channel blockers 3, 1

Important Precautions

• Do not combine with ACE inhibitors or other ARBs - this combination is not recommended and potentially harmful 3
• Monitor blood pressure closely in dialysis patients due to risk of orthostatic hypotension 1
• Monitor for hyperkalemia, especially in patients with chronic kidney disease or those on potassium supplements 3
• When initiating therapy for cardiovascular risk reduction, monitor blood pressure and adjust other antihypertensive medications as needed 1

Initiation Strategy Based on Hypertension Severity

• Stage 1 hypertension: Initiation with single-agent telmisartan is reasonable 4
• Stage 2 hypertension (BP >20/10 mmHg above target): Initiate with 2 first-line agents of different classes 4

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