Telmisartan-based monotherapy and combination regimens for blood pressure control in adults with hypertension: a systematic review, meta-analysis, and GRADE assessment.
Alsel B, Alanazi M, et al. • BMC cardiovascular disorders • 2026
Telmisartan-based regimens, particularly fixed-dose and multidrug combinations, effectively reduce office and ambulatory blood pressure and improve blood pressure response, with broadly comparable short-term safety and less edema, though effect sizes are comparator-dependent and certainty of evidence ranges from very low to moderate.
Risk ratio for blood pressure response was 1.68 (95% CI: 1.31 to 2.16)
Certainty of evidence for blood pressure response was rated as moderate
Blood pressure control achievement (reaching target) was not significantly improved (RR 1.44; 95% CI: 0.92 to 2.24)
Certainty of evidence for blood pressure control achievement was rated as very low
Results
Edema occurred significantly less frequently with telmisartan-based therapy compared to control regimens.
Risk ratio for edema was 0.33 (95% CI: 0.15 to 0.73), indicating a 67% relative reduction
Certainty of evidence for edema was rated as moderate
This finding likely reflects comparison with calcium channel blocker-containing regimens, which are associated with peripheral edema
Overall adverse events, dizziness, and headache were comparable between telmisartan and comparator groups
Results
Overall adverse events, dizziness, and headache rates were comparable between telmisartan-based and comparator regimens.
Certainty of evidence for overall adverse events and individual adverse effects (dizziness, headache) ranged from very low to low
No statistically significant differences were found for these safety outcomes
Short-term safety profile of telmisartan-based therapy was described as 'broadly comparable'
Limited long-term safety data were available across included trials
Methods
The systematic review included 25 reports from 24 unique trials enrolling 6,521 adults with hypertension across multiple comparison designs.
Two reports presented secondary outcomes from the same underlying trial, yielding 24 unique trials
Study designs included placebo-controlled, usual-care-controlled, active-comparator, and telmisartan-combination-versus-telmisartan-monotherapy designs
Databases searched included PubMed/MEDLINE, Scopus, Web of Science, and Cochrane CENTRAL from inception to 2026
Risk of bias was assessed using RoB 2; certainty of evidence was evaluated using GRADE
The authors noted a predominance of Asian-population trials, warranting cautious generalizability
Discussion
Heterogeneity, limited long-term data, and predominance of Asian-population trials were identified as key limitations warranting cautious interpretation.
The authors called for 'larger, higher-quality, and more geographically diverse confirmatory studies'
Certainty of evidence across outcomes ranged from very low (blood pressure control achievement, some adverse events) to moderate (ambulatory blood pressure, response rate, edema)
No outcomes achieved high certainty of evidence under GRADE assessment
Fixed-dose and multidrug combinations were highlighted as particularly effective telmisartan-based regimens
What This Means
This research suggests that telmisartan, a blood pressure medication in the angiotensin receptor blocker (ARB) class, effectively lowers blood pressure when used alone or in combination with other medications. Across 24 clinical trials involving over 6,500 adults with high blood pressure, telmisartan-based treatments reduced both the upper (systolic) and lower (diastolic) blood pressure readings measured in a clinic setting by roughly 6 and 5 mm Hg, respectively. When 24-hour continuous blood pressure monitoring was used—considered a more accurate measure—reductions were similar or slightly larger, though this finding came from only two studies. People taking telmisartan-based regimens were also 68% more likely to show a meaningful blood pressure response compared to those on other treatments or placebo.
This research also suggests that telmisartan-based regimens are associated with less fluid retention (edema, or swelling) compared to some other blood pressure-lowering drug classes, with about one-third the risk of edema seen in comparator groups. Other side effects such as dizziness and headache were similar between telmisartan and comparison treatments. Combination therapies involving telmisartan—particularly fixed-dose combinations with other agents—appeared especially effective at lowering blood pressure. However, the strength of evidence for most findings was rated as low or very low, meaning that future higher-quality studies could change these conclusions.
The findings come with important caveats: how much telmisartan reduces blood pressure depends heavily on what it is being compared to, most of the included studies were conducted in Asian populations (which may limit applicability to other groups), and there is little data on long-term safety. The review highlights that while telmisartan-based therapy appears to be a safe and effective option for managing high blood pressure, larger and more geographically diverse studies are needed to confirm these conclusions with greater confidence.
Alsel B, Alanazi M, Alrawaili A, Alenezi S, Esmaeel S, Fawzy M, et al.. (2026). Telmisartan-based monotherapy and combination regimens for blood pressure control in adults with hypertension: a systematic review, meta-analysis, and GRADE assessment.. BMC cardiovascular disorders. https://doi.org/10.1186/s12872-026-06488-z