Fixed-dose combination: angiotensin II receptor blocker plus thiazide diuretic
Updated · Methodology
Second line
Essential hypertension uncontrolled on telmisartan monotherapy. Per ESH/ 2023 and SEH-LELHA 2023 – second-line. Dose: 40/12.5, 80/12.5, 80/25 mg once daily in the morning. Full effect at 4–8 weeks. Telmisartan fits the non-dipper pattern and morning BP surge (24-h T½).
Sources
ICD-10: I10 · ICD-11: BA00
Telmisartan blocks AT1 receptors of angiotensin II with the longest T½ among ARBs (24 h), giving stable 24-hour BP control including the early-morning surge. It also partially activates PPAR-gamma (in vitro – the clinical effect on insulin resistance has not been confirmed in large RCTs). Hydrochlorothiazide is the diuretic component.
Contraindicated from the 2nd trimester. ARBs and ACE inhibitors cause fetopathy: oligohydramnios, fetal renal failure, skull hypoplasia, limb contractures. In women of reproductive age planning pregnancy, switch in advance to methyldopa, labetalol, or slow-release nifedipine (ACOG 222 (2020), SEGO 2023).
Milk excretion data for the fixed combination are limited. For breastfeeding ESH 2023 and ACOG 2020 recommend switching to enalapril (RID 0.2%), captopril (RID 0.02%), methyldopa, or labetalol.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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Telmisartan + Hydrochlorothiazide is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Telmisartan + Hydrochlorothiazide (≥ 1 in 100): Dizziness, Hypotension, Hyperkalemia, Hyponatremia, Hyperuricemia, Elevated creatinine. See the Safety section for uncommon and serious reactions.
Contraindicated from the 2nd trimester. ARBs and ACE inhibitors cause fetopathy: oligohydramnios, fetal renal failure, skull hypoplasia, limb contractures. In women of reproductive age planning pregnancy, switch in advance to methyldopa, labetalol, or slow-release nifedipine (ACOG 222 (2020), SEGO 2023).
Milk excretion data for the fixed combination are limited. For breastfeeding ESH 2023 and ACOG 2020 recommend switching to enalapril (RID 0.2%), captopril (RID 0.02%), methyldopa, or labetalol.
Telmisartan + Hydrochlorothiazide is contraindicated in: Hypersensitivity to sartan, thiazides, or sulfonamides; Pregnancy (2nd-3rd trimester); Bilateral renal artery stenosis; Severe renal impairment (CrCl <30 for the thiazide component); Severe hepatic impairment, cholestasis. Full list in the Safety section.
Valsartan, Valsartan + Hydrochlorothiazide, Amlodipine + Olmesartan, Amlodipine + Olmesartan + Hydrochlorothiazide, Amlodipine + Valsartan, Candesartan, Irbesartan, Olmesartan medoxomil