Summary: ARBs are among the most widely used classes of antihypertensive drugs and are associated with significantly lower treatment discontinuation rates for adverse events than those all other antihypertensive therapies, with similar rates to placebo. Among several beneficial effects on CV system, brain and kidney, telmisartan reduces albuminuria more than other BP-lowering drugs, is effective at delaying the progression of diabetic and non-diabetic CKD, prevents or regresses HMOD and are is particularly recommended in those patients with high cardiovascular risk. According to the new ESH (2023 and 2024) guidelines, the treatment of hypertension should be preferentially based on combinations of the ARB or ACE inhibitor with the CCB and or a thiazide/thiazide-like diuretic, which are now widely available in a single pill and in the range of doses facilitating simplification of the doses.

The current review summarizes the current place of telmisartan, AT-1 receptor antagonist with multiple faces, in the treatment of hypertension with the specific goal to overview the efficacy and tolerability of telmisartan in the treatment of stage 2 and stage 3 hypertension, also in combination with hydrochlorothiazide or amlodipine for the management of patients with hypertension and high cardiovascular risk. For patients whose BP is not controlled by two-drug combination therapy, an option may be to use three-drug combination therapy – telmisartan, amlodipine and hydrochlorothiazide.