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Telmisartan

Angiotensin II receptor blocker with blood pressure-lowering and cardiovascular protective effects.

1 min read 7 sources

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Compound approved · since 1998 according to ChEMBLLab tested in the shop

Summary

At a glance

Sources checked on 26 Oct 2026

ONTARGET

25,620 patients

primary outcome 16.7% with telmisartan, 16.5% with ramipril⁴

Cough with telmisartan

1.1 %

4.2% with the ACE inhibitor ramipril⁴

Primary outcome in TRANSCEND

15.7 %

17.0% on placebo, difference not significant⁵

Kidney function worsened

6.4 %

after 3 months in heart failure, 22.9% with enalapril¹

Insulin resistance after 12 weeks

1.79 HOMA-IR

median, baseline 4.1; 3.45 with other blood pressure drugs²

According to ChEMBL telmisartan blocks the angiotensin II type 1 receptor (AT1). Vessels widen and blood pressure falls.⁷
In ONTARGET with 25,620 patients telmisartan was equivalent to the ACE inhibitor ramipril. Cough was less common (1.1 versus 4.2 percent).⁴
In patients who could not tolerate an ACE inhibitor the primary outcome in TRANSCEND was not significantly less common than on placebo (15.7 versus 17.0 percent).⁵
Smaller trials found less kidney worsening than with enalapril and better insulin sensitivity than with other blood pressure drugs.¹²
Telmisartan is an approved compound. Everything here is the state of research, not a recommendation.⁷

Profile

Updated June 2026

How long does it stay in the body?

Share left after one dose, calculated with a half-life of ~24 hours

Half-life ~24 hours

After 48 hours: 25 %

Hour 24 · 50 %Hour 48 · 25 %Hour 72 · 12.5 %Hour 120 · 3.1 %

Simplified model without an absorption phase, half-life from the TPD lexicon.

Class

Angiotensin II receptor antagonist

ARB

Use

Blood pressure control

cardiovascular protection

Half-life

Approximately 24 hours

Status

Prescription required

Sizes

40 to 80 mg

3 sizes in the shop

Contents 12 sections

At a glance
What is Telmisartan?
How it works
Administration and dosing
What the research shows
Research status
Side effects
Storage
Related compounds
FAQ
Glossary
Sources

What is Telmisartan?

Telmisartan is an angiotensin II receptor blocker (ARB) used to treat hypertension. It blocks the binding of angiotensin II to AT1 receptors, leading to blood vessel relaxation and blood pressure reduction. Telmisartan has a long half-life enabling once-daily dosing.

Research suggests telmisartan offers cardiovascular and metabolic benefits beyond blood pressure reduction. This information is for research and educational purposes only. No medical advice.

Comparison

Three ways to lower blood pressure

Sartans block the receptor, ACE inhibitors the production of angiotensin II, calcium channel blockers the vessel muscles. Tap a card to open its entry.

Sartan Telmisartan AT1

Sartan Losartan (Cozaar) AT1 ACE inhibitor Ramipril (Altace) ACE Calcium channel blocker Amlodipine (Norvasc) L-type channel

According to ChEMBL: telmisartan and losartan block the AT1 receptor, ramipril inhibits angiotensin-converting enzyme (ACE), amlodipine blocks voltage-gated L-type calcium channels. ⁷

How it works

Telmisartan works through selective blockade of angiotensin II type 1 (AT1) receptors. The renin-angiotensin-aldosterone system (RAAS) is inhibited, resulting in:

Vasodilation (blood vessel relaxation)
Reduced vascular resistance
Blood pressure lowering
Improved endothelial function
Anti-inflammatory effects on vessel walls

Where it acts

Where telmisartan acted in studies

Tap a point or a card. Colour = AT1 receptor, grey = observed in studies.

Blood vessels

Blood pressure 4.0 over 2.2 mmHg lower than on placebo on average⁵

AT1
Heart

Cardiovascular death, heart attack or stroke in 13.0 instead of 14.8 percent⁵

Observed in trials
Kidneys

Kidney function worsened less often than with enalapril (6.4 versus 22.9 percent)¹

Observed in trials
Blood sugar and insulin

HOMA-IR fell to 1.79 instead of 3.45²

Observed in trials
Airways

Cough less common than with ramipril (1.1 versus 4.2 percent)⁴

Observed in trials

Targets in the ChEMBL database⁷

Compound CHEMBL1017: one recorded mechanism, Antagonist (blocker).

Angiotensin II type 1 receptor

Gene: AGTR1
UniProt: P30556
ChEMBL: CHEMBL227
Action: Antagonist (blocker)

Transparent blood vessel seen from inside, blue molecules sit on round docking sites of the vessel wall — Telmisartan occupies the AT1 receptor, the vessels widen. Symbolic image.

Administration and dosing

Dosing

Dosing, titration and syringe

Loading the dosing information …

Getting started and stepping up, drawn as a staircase
Units on the U-100 syringe for every step
How long one vial lasts

Tablet once a day. Symbolic image.

What the research shows

Clinical trials indicate that telmisartan:

Effectively lowers blood pressure and maintains control
May improve insulin sensitivity in diabetic patients
Reduces cardiovascular events
Lowers systemic inflammatory markers
Shows synergistic effects in combination therapies (with calcium channel blockers or statins)
Improves endothelial function

Meta-analyses show that telmisartan-based combinations are beneficial for controlling both blood pressure and lipid status.

Study results

What the trials measured

Interactive: switch tabs, tap points, show or hide arms. Arms are named relative to each other, no dosing advice.

Cardiovascular events over about 56 months⁴

Share with cardiovascular death, heart attack, stroke or hospital stay for heart failure, 25,620 high-risk patients

Primary outcome⁴

Ramipril (comparator) 16.5%

Telmisartan 16.7%

Telmisartan plus ramipril 16.3%

Values from the abstract (relative risk 1.01). The combination brought no benefit but more kidney problems (13.5 versus 10.2 percent).

Events in ACE inhibitor intolerance⁵

Share in percent, 5,926 patients, about 56 months

Primary outcome⁵ not significant

Placebo 17.0%

Telmisartan 15.7%

Cardiovascular death, heart attack or stroke⁵

Placebo 14.8%

Telmisartan 13.0%

Cardiovascular hospital stay⁵

Placebo 33.0%

Telmisartan 30.3%

Values from the abstract. Blood pressure was 4.0 over 2.2 mmHg lower on average. The secondary outcome was only borderline significant and no longer after correction.

Heart failure with impaired kidney function¹

Share in percent, 107 patients over 6 months

Kidney function worsened¹ after 3 months

Enalapril (comparator) 22.9%

Telmisartan 6.4%

Dose lowered or stopped¹ after 6 months

Enalapril (comparator) 56.5%

Telmisartan 35.7%

Hospital stay for heart failure¹ by the end of the trial

Enalapril (comparator) 55.3%

Telmisartan 34.1%

Values from the abstract, small open trial. There were 5 deaths in each group. After 6 months the difference in kidney function was no longer significant.

Insulin resistance (HOMA-IR)²

Median, 70 patients with type 2 diabetes and high blood pressure, 12 weeks

At baseline²

Other blood pressure drugs (comparator) 3.90%

Telmisartan 4.10%

After 12 weeks²

Other blood pressure drugs (comparator) 3.45%

Telmisartan 1.79%

Values from the abstract, open-label trial. Lower means better insulin sensitivity. Endothelin-1 fell similarly in both groups.

Glass heart with vessels on a bright lab bench between racks of sample tubes — Large trials on heart and circulation. Symbolic image.

Research status

Where the research stands

Telmisartan has been approved since 1998. On ClinicalTrials.gov 349 trials list telmisartan among their interventions, many on fixed combinations. Shown are ONTARGET and TRANSCEND, the heart failure trial and some large phase 3 trials. As of 26 Oct 2026. ⁶

Preclinical Basis: blockade of the AT1 receptor
Phase 1 no registered trial
Phase 2 no registered trial
Phase 3 4 trials, 3 completed
Approval since 1998 according to ChEMBL

0 participants in phase 3 Planned figures for running trials Approved: ChEMBL lists telmisartan with phase 4 as the highest phase and first approval in 1998.⁷

Show all 6 trials on a timelineHide timeline 5 completed 1 running 2 with results

Phase 3

Phase 4

Without phase

Bar: start to primary endpoint (planned for running trials). Green = completed, blue = progress until 26 Oct 2026.

Side effects

Common side effects include:

Dizziness or headaches
Fatigue
Hyperkalemia (in patients with impaired kidney function)
Cough (less common than with ACE inhibitors)
Gastrointestinal discomfort

More serious but rare side effects include angioedema and kidney function impairment. Telmisartan is contraindicated in pregnancy.

Tolerability

Side effects versus ramipril

Out of 100 participants per group, how many had the event over about 56 months.

4 of 100 Ramipril (comparator)

1 of 100 Telmisartan

Event	Ramipril (comparator)	Telmisartan
Cough⁴	4%	1%
Low blood pressure with symptoms⁴	2%	3%
Angioedema⁴	0%	0%
Fainting⁴	0%	0%

Values from the abstract. In TRANSCEND 21.6 percent stopped telmisartan for good, 23.8 percent stopped placebo.⁴⁵

Storage

Telmisartan tablets should be stored in a dry, cool place, protected from light. Storage temperature should be between 15-30 degrees Celsius. Original containers protect against moisture and should remain tightly sealed. Do not refrigerate.

Three white capsule bottles on a bright shelf next to a folded light blue towel — Store dry and protected from light, not in the fridge. Symbolic image.

Related compounds

Same targets or a different path: all in the TPD lexicon.

Telmisartan

Losartan (Cozaar) Same receptor, also a sartan Ramipril (Altace) Comparator in ONTARGET Amlodipine (Norvasc) Common fixed combination with telmisartan Rosuvastatin (Crestor) Studied in combination for blood lipids

FAQ

Common questions about Telmisartan

Short answers, each backed by the sources below.

Is telmisartan approved?

Yes. ChEMBL lists telmisartan with phase 4 as the highest phase and first approval in 1998. ClinicalTrials.gov lists 349 trials with telmisartan, as of 26 October 2026.⁷⁶

What did ONTARGET show?

25,620 patients with vascular disease or high-risk diabetes received ramipril, telmisartan or both. After about 56 months the primary outcome was 16.5, 16.7 and 16.3 percent. Telmisartan was equivalent, the combination brought no benefit but more side effects.⁴

And if an ACE inhibitor is not tolerated?

TRANSCEND tested this in 5,926 patients against placebo. The primary outcome was not significantly less common at 15.7 versus 17.0 percent. Cardiovascular death, heart attack or stroke occurred in 13.0 versus 14.8 percent, also not significant after correction.⁵

Why less cough than with ACE inhibitors?

According to ChEMBL telmisartan blocks the AT1 receptor and not the enzyme ACE. In ONTARGET 1.1 percent had cough with telmisartan, 4.2 percent with ramipril. Angioedema occurred in 0.1 versus 0.3 percent.⁷⁴

What was measured in heart failure with weak kidneys?

In a small open trial with 107 patients kidney function worsened less often than with enalapril after 3 months (6.4 versus 22.9 percent). Hospital stays for heart failure were less common (34.1 versus 55.3 percent), there were 5 deaths in each group.¹

What do the trials on insulin and combinations show?

In 70 patients with diabetes and high blood pressure HOMA-IR fell to 1.79 after 12 weeks instead of 3.45 with other blood pressure drugs. A meta-analysis of 3 trials found stronger blood pressure lowering with amlodipine and better LDL values with rosuvastatin, tolerability was similar.²³

Glossary

Terms explained briefly

Dotted words in the text open these explanations directly.

ACE inhibitor: Compound that slows the production of angiotensin II. A typical side effect is dry cough.
Angioedema: Sudden swelling of skin and mucosa, for example of the lips or tongue.
Angiotensin II: Hormone that narrows the vessels and retains salt in the kidney.
AT1 receptor: Docking site for angiotensin II on vessels, kidney and adrenal gland. When activated, blood pressure rises.
Endothelium: Inner cell layer of the blood vessels that helps regulate their width.
HOMA-IR: Value calculated from fasting glucose and fasting insulin. Higher means more insulin resistance.
Hyperkalaemia: Too much potassium in the blood, a risk for the heart especially with impaired kidneys.
Placebo: Dummy preparation without active substance. Comparing against it shows what is due to the substance itself.
RAAS: Renin-angiotensin-aldosterone system, a hormone circuit that controls blood pressure and salt balance.
Sartan (ARB): Drug class that blocks the receptor for angiotensin II.
Vasodilation: Widening of the blood vessels, blood pressure falls.

Evidence

Sources

Show all 7 sourcesHide sources 2 Studies1 Trial registry4 Database checked 26 Oct 2026

Studies

ONTARGET: telmisartan, ramipril or both in high-risk patients
Yusuf et al., New England Journal of Medicine, 2008

DOI 10.1056/NEJMoa0801317 PMID 18378520 NCT00153101

Checked 26 Oct 2026 via doi.org, Crossref, PubMed
TRANSCEND: telmisartan in ACE inhibitor intolerance
Yusuf et al., The Lancet, 2008

DOI 10.1016/S0140-6736(08)61242-8 PMID 18757085 NCT00153101

Checked 26 Oct 2026 via doi.org, Crossref, PubMed

Trial registry

All trials with telmisartan on ClinicalTrials.gov
ClinicalTrials.gov, U.S. National Library of Medicine

Checked 26 Oct 2026 via ClinicalTrials.gov API v2

Database

TRIUMF: telmisartan versus enalapril in heart failure with kidney impairment (PubMed Central)
Samir et al., The Egyptian Heart Journal, 2023 (DOI 10.1186/s43044-023-00398-7)

PMID 37552407 NCT04736329

Checked 26 Oct 2026 via PubMed Central, PubMed, doi.org, Crossref
Telmisartan versus other blood pressure drugs in diabetes: insulin and endothelin-1 (PubMed record)
Gomaz et al., Indian Journal of Medical Research, 2026 (DOI 10.25259/IJMR_1859_2025)

PMID 41934432

Checked 26 Oct 2026 via PubMed, doi.org, Crossref
Meta-analysis: telmisartan with amlodipine or rosuvastatin (PubMed Central)
Asim et al., Clinical Cardiology, 2025 (DOI 10.1002/clc.70211)

PMID 41292423

Checked 26 Oct 2026 via PubMed Central, PubMed, doi.org, Crossref
Telmisartan, losartan, ramipril and amlodipine in ChEMBL (targets and approval)
ChEMBL, EMBL-EBI (CHEMBL1017, CHEMBL995, CHEMBL1168, CHEMBL1200402)

Checked 26 Oct 2026 via ChEMBL

In the shop

Telmisartan in the catalog

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