What is the appropriate next step in management for a 55‑year‑old man with hypertension controlled on telmisartan 40 mg daily, normal blood pressure (130/70 mm Hg) and exam, who presents solely for interpretation of a recent standard metabolic panel?

Management of a 55-Year-Old Man with Well-Controlled Hypertension

Continue telmisartan 40 mg daily, review the metabolic panel results for any abnormalities (particularly electrolytes and renal function), reinforce lifestyle modifications, and schedule routine follow-up in 3-6 months with continued home blood pressure monitoring. 1, 2

Blood Pressure Assessment

Your patient's current blood pressure of 130/70 mmHg represents excellent control on telmisartan 40 mg daily. 1, 2

• This BP is at target according to the 2020 International Society of Hypertension guidelines, which recommend treating to <130/80 mmHg for most hypertensive patients. 1
• The systolic BP of 130 mmHg falls within the optimal range of 120-129 mmHg recommended by current European guidelines for cardiovascular risk reduction. 2, 3
• No medication adjustment is needed at this time given the excellent BP control. 1, 4

Metabolic Panel Interpretation

Review the standard metabolic panel specifically for:

• Serum creatinine and eGFR: Essential for monitoring renal function in patients on RAS blockers like telmisartan. 1
• Serum potassium: RAS inhibitors can cause hyperkalemia, particularly in patients with renal impairment. 1, 2
• Serum sodium: To assess for any electrolyte disturbances. 1
• Fasting glucose: Given his age and hypertension, screening for diabetes is important as it would change cardiovascular risk stratification and potentially BP targets. 1

If the metabolic panel is entirely normal, this confirms safe continuation of current therapy. 2

Cardiovascular Risk Assessment and Additional Screening

This is the critical next step beyond simply interpreting labs. A 55-year-old man with hypertension requires comprehensive cardiovascular risk stratification to guide additional preventive interventions. 1, 3

Lipid Management

• Order a lipid panel if not recently done (within the past year). 1
• Based on his hypertension alone, he likely qualifies as moderate-to-high cardiovascular risk. 1
• If LDL-C is >100 mg/dL (2.6 mmol/L), statin therapy should be initiated for primary prevention in a hypertensive patient. 1
• Target LDL-C <100 mg/dL (2.6 mmol/L) for high-risk patients without established CVD. 1

Diabetes Screening

• Fasting glucose should be <126 mg/dL (7 mmol/L) or HbA1c <7% (53 mmol/mol). 1
• If diabetes is present, this elevates his cardiovascular risk and may warrant more aggressive lipid management (LDL-C target <70 mg/dL). 1

Renal Function Monitoring

• Check for microalbuminuria if not done in the past year, as hypertension is a major risk factor for chronic kidney disease development. 1
• Telmisartan provides renoprotection and reduces albuminuria beyond BP control. 1, 5, 6

Lifestyle Modification Reinforcement

Even with excellent BP control, lifestyle interventions remain critical for reducing residual cardiovascular risk. 1, 3

Dietary Recommendations

• Adopt Mediterranean or DASH diet emphasizing fruits, vegetables, fish, nuts, unsaturated fatty acids, and low-fat dairy. 1, 3
• Restrict sodium to <2g/day (approximately 5g salt/day). 1, 3
• Limit free sugar to <10% of energy intake and avoid sugar-sweetened beverages. 2, 3
• Increase dietary potassium through food sources. 1

Weight and Physical Activity

• Target BMI 20-25 kg/m² and waist circumference <94 cm for men. 2, 3
• Engage in ≥150 minutes of moderate-intensity aerobic exercise weekly, plus resistance training. 2, 3

Tobacco and Alcohol

• Congratulate him on 19 years of smoking cessation and reinforce continued abstinence. 1, 3
• Limit alcohol to <100g/week pure alcohol, preferably avoid completely. 2, 3

Medication Adherence and Optimization

Current Regimen Assessment

• Telmisartan 40 mg once daily is appropriate for his current BP control. 4, 5, 7
• Telmisartan has the longest elimination half-life among ARBs, providing sustained 24-hour BP control. 5, 8, 6
• The usual starting dose is 40 mg daily, with dose-related BP response up to 80 mg. 4, 7
• Most antihypertensive effect is apparent within 2 weeks, with maximal reduction after 4 weeks. 4

Adherence Strategies

• Encourage taking medication at the same time daily to establish habitual patterns. 2, 3
• Implement home BP monitoring to improve control and patient engagement. 2, 3
• Counsel on the importance of lifelong treatment even with excellent control, as discontinuation leads to BP elevation. 1, 3

Follow-Up Plan

Monitoring Schedule

• Schedule routine follow-up in 3-6 months if all labs are normal and BP remains controlled. 2, 3
• Measure BP at every routine visit going forward. 2
• Repeat metabolic panel annually to monitor renal function and electrolytes on telmisartan. 1, 2
• Annual lipid panel and diabetes screening if not already established. 1

Home Blood Pressure Monitoring

• Instruct on proper home BP monitoring technique to detect any loss of control between visits. 2, 3
• Home monitoring improves BP control and helps identify white-coat or masked hypertension. 2

Common Pitfalls to Avoid

• Do not discontinue or reduce telmisartan simply because BP is well-controlled—hypertension requires lifelong treatment. 3
• Do not miss the opportunity for comprehensive cardiovascular risk reduction beyond BP control alone (lipids, glucose, lifestyle). 1, 3
• Do not forget to monitor renal function and potassium in patients on RAS blockers, even when asymptomatic. 1, 2
• Do not assume normal BP in the office means 24-hour control—encourage home monitoring to confirm sustained control. 2, 8
• Do not overlook screening for target organ damage (LVH, microalbuminuria) which would intensify treatment goals. 1, 2