REVIEW ON THE ROLE OF TELMISARTAN IN MANAGING HYPERTENSION WITH EMPHASIS ON EARLY MORNING BP CONTROL

Hypertension remains a leading global contributor to cardiovascular morbidity and mortality, and growing evidence highlights the prognostic relevance of blood pressure (BP) variability and inadequate control during the early morning hours. Ambulatory blood pressure monitoring (ABPM) has demonstrated that many treated patients experience suboptimal trough-phase BP reduction, resulting in an exaggerated early morning BP surge (EMBS) that coincides with a peak incidence of myocardial infarction, stroke, and sudden cardiac events. In this context, the selection of long-acting antihypertensive agents with sustained 24-hour efficacy is clinically important. Telmisartan, a long-acting angiotensin II type-1 receptor (AT₁) blocker, exhibits a prolonged elimination half-life, high receptor affinity, slow dissociation kinetics, and a favourable trough-to-peak ratio, contributing to consistent end-of-dose BP control, including during the early morning “high-risk window.” Beyond AT₁ receptor blockade, telmisartan demonstrates partial PPAR-γ and PPAR-α modulatory activity, conferring additional metabolic, vascular, anti-inflammatory, and anti-remouldeing benefits. Evidence from randomized clinical trials, PROBE-designed studies, and community-based ABPM investigations indicates that telmisartan provides superior late-dose, nocturnal, and early-morning BP suppression compared with several other ARBs, ACE inhibitors, and calcium channel blockers, and maintains residual BP control even after a missed dose. Its favourable pharmacokinetic profile, minimal renal dose adjustment requirement, and good tolerability further support its therapeutic utility, particularly in patients with metabolic syndrome, diabetes, or cardiovascular risk. While contraindications include pregnancy and severe hepatic impairment, the overall evidence suggests that telmisartan is a reliable, metabolically advantageous, and long-acting antihypertensive agent with significant potential to attenuate early morning BP surge and reduce circadian-linked cardiovascular risk.