Explanation
Micardis (Telmisartan) is an angiotensin II receptor blocker (ARB) indicated for the treatment of hypertension. It selectively blocks angiotensin II at the AT
1 receptor, reducing vasoconstriction and aldosterone-mediated sodium and water retention. Therefore, angiotensin II receptor blocker is the correct answer; the other options are adrenergic receptor blockers.
Telmisartan is also indicated to reduce the risk of myocardial infarction, stroke, or cardiovascular death in patients 55 years or older who are at high cardiovascular risk and unable to take an angiotensin-converting enzyme (ACE) inhibitor.
For hypertension, the recommended starting dose is 40 mg orally once daily; the usual dosage range is 20–80 mg once daily. It may be administered with or without food.
Telmisartan may cause hyperkalemia, hypotension, and deterioration in renal function. It carries a boxed warning for fetal toxicity and should be discontinued as soon as pregnancy is detected.
Key Points:
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Monitor blood pressure, serum potassium, and renal function after initiation and dosage increases.
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NSAIDs may reduce the antihypertensive effect and increase the risk of acute kidney injury, particularly in older or volume-depleted patients.
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Avoid concomitant aliskiren in patients with diabetes because dual renin-angiotensin system blockade increases renal, hypotension, and hyperkalemia risks.
Exam Pearl: Unlike ACE inhibitors, ARBs do not inhibit bradykinin breakdown and are less likely to cause cough.
