As I have initiated telmisartan at 20mg/day a few days ago, I am certanly interested in whether in fact there are no pleiotropic benefits to be had at that dose (beyond the BP lowering, of course). Especially if I may not have the headroom to escalate the dose to 80+mg.
It is commonly understood that while the BP lowering is sharply attenuated beyond 80mg, the metabolic/pleiotropic benefits continue to accrue beyond that dose without as sharp an attenuation.
Be that as it may, this does not mean that at a low 20mg dose ānone of the other potential benefits have been observed.ā Here is a study that shows otherwise:
Comparative Effects of Telmisartan and Valsartan on Insulin Resistance in Hypertensive Patients with Metabolic Syndrome
āObjective Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that includes hyperglycemia, dyslipidemia, hypertension and increased waist circumference. Individuals with this syndrome are at increased risk for development of cardiovascular disease. Since an insulin-resistance state has a critical role in the development of MetS, there is growing concern about insulin-sensitizing effects of antihypertensives, including angiotensin II receptor blockers (ARBs). Telmisartan has been reported to have an effect on the activity of peroxysome proliferator-activated receptorĪ³, a well-known target for insulin-sensitizing antidiabetic drugs. The aim of this study was to determine the effects of administration of two different ARBs at low doses (telmisartan at 20 mg/day and valsartan at 40 mg/day) on insulin sensitivity.
Methods Patients with MetS meeting the Japanese criteria were treated with telmisartan or valsartan for 4 weeks in combination with lifestyle modification.
Results A significant reduction in blood pressure was found after 4 weeks of both treatments. The homeostasis model assessment of insulin resistance (HOMA-R) was significantly reduced by telmisartan compared to the baseline value (3.11Ā±2.06 vs 2.56Ā±1.48, p=0.031) but was not significantly changed by valsartan. A statistically significant correlation was found between HOMA-R at baseline and changes in HOMA-R after 4 weeks of treatment only in telmisartan-treated subjects. Body mass index, glycosylated hemoglobin and lipid profile were not changed by either treatment.
Conclusion Our data revealed that treatment with telmisartan even at a low dose improves insulin sensitivity in hypertensive patients with MetS. This ameliorating effect of telmisartan on glucose metabolism clinically deserves to be considered.ā
Obviously, going up in dose would have a more significant effect, but this shows that even at a low 20mg dose, telmisartan can have benefits on glucose metabolism.
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I am currently taking Telmisartan 20 mg, but have also taken 40 mg. My insulin levels in my blood are very, very good and much better than I expected. It may be due to the Telmisartan.
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I was thinking of you, Chris. I knew you went down to 20mg after your fainting scare, so thought the low dose study would be relevant not just to me, but to more readers, which encouraged me to post this. My research continues 
!
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I think the fainting spell may have been the combination of Telmisartan and Citrulline at night. I moved my Telmisartan to the morning and that seems to help. I may eventually try going back up to 40 mg if things continue to improve.
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Effect of Systolic Blood Pressure Measurement Error on the Cost-Effectiveness of Intensive Blood Pressure Targets
https://www.acpjournals.org/doi/10.7326/ANNALS-25-00560
Your body will adjust to the new low in most cases. When I went to 80mg, I had occasional faintness when standing up and every time after a set of squats, leg presses or deadlifts. After a few weeks it stopped happening.
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Also, I look out for the feeling of nausea which preceded fainting. Usually if I eat something the nausea will go away. It may be a combination of hypoglycemia and hypotension that caused the fainting as it happened when my blood sugar is usually the lowest (2-3 am).
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Good point. I remember the slight nausea now too.
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RobTuck
#189
This is potentially good news for individual like my wife who does not need a BP medication but might tolerate 20 mg/day of TM. However, the implied scale caught my attention in this somewhat old study. What am I missing and, of course, have there been replications to validate this single 2007 finding?
DrT
#190
I have been on 20mg Telmisartan for about a week. No ill effects. Going up to 30 mg next week; then 40.
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Interesting. The full BP lowering effect is supposedly seen after 4 weeks. I therefore intend to stay at 20mg/day for 5 weeks, measuring my BP frequently and monitoring any effects. Then after 5 weeks, jump to 40mg/day and stay on that 3-4 months before attempting 80mg, depending on my numbers and how I feel.
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RobTuck
#192
As compared with other blood pressure medications, and prescription medications in general for that matter, the side effects, of telmisartan are generally quite mild and transitory. I had no side effects at my initial dose of 40 mg and, based on the desire to secure benefits beyond lowering blood pressure, I jumped to 80 mg, again with no side effects. Friends I know who take telmisartan have commented that their experience has been free from side effects. I was most concerned about my potassium levels but they did not change at either dose.
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I have started taking Telmisartan 40 mg again, but this time in the morning , away from my citrulline dose. I think it works best when I take it in the morning. I will keep my eyes open for any signs of potential problems.
Telmesartan is one of two anti hypertensives that cross the blood brain barrier where it is most needed for cerebral perfusion. Once a day is enough. Amlodapineisan ideal addition if needed and removes calcium from blood vessels. Gbest MD
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The effect of empagliflozin on circulating endothelial progenitor cells in patients with diabetes and stable coronary artery disease
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EPCs (endothelial progenitor cells) decline with age.
Telmisartan induces proliferation of human endothelial progenitor cells via PPARgamma-dependent PI3K/Akt pathway
āThese findings suggest that telmisartan might contribute to endothelial integrity and vasculogenesis in ischemic regions by increasing numbers of EPCs.ā
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I wonder if telmisartan might be useful for those taking ezetimibe.
The Antihypertensive Drug Telmisartan Protects Oligodendrocytes from Cholesterol Accumulation and Promotes Differentiation by a PPAR-Ī³-Mediated Mechanism
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