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| CASE REPORT |
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| Year : 2021 | Volume
: 1
| Issue : 2 | Page : 59-60 |
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A rare adverse effect of telmisartan: Headache
Ravi Kant, Prakash Tendulkar, Divanshee Sharma, Manjunath Totaganti
Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| Date of Submission | 21-Feb-2021 |
| Date of Acceptance | 26-Oct-2021 |
| Date of Web Publication | 28-Feb-2022 |
Correspondence Address:
Ravi Kant
Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand.
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JCDM.JCDM_3_21
Hypertension is one of the most common noncommunicable diseases prevalent in the community. Its treatment is largely dependent on pharmacological and nonpharmacological strategies. The pharmacological treatment is often associated with vivid side effects both common and rare adverse events. Here we report a rare adverse effect of a common antihypertensive drug, Telmisartan. The adverse event was suspected based on temporal association of starting the drug and appearance of headache. It was further strengthened by disappearance once the drug was withdrawn. Keywords: Headache, hypertension, telmisartan
How to cite this article:
Kant R, Tendulkar P, Sharma D, Totaganti M. A rare adverse effect of telmisartan: Headache. J Cardio Diabetes Metab Disord 2021;1:59-60 |
| Introduction | |  |
Telmisartan is a nonpeptide angiotensin II receptor antagonist selectively and insurmountably inhibits the angiotensin II AT1 receptor subtype without impacting additional receptor systems concerned in cardiovascular regulation. Studies in healthy recruits have shown that oral doses of telmisartan varying from 1 to 320 mg are well tolerated, without any influence on heart rate, electrocardiogram (EKG), or clinical laboratory parameters. In patients with mild-to-moderate hypertension, it is recommended at doses of 20–160 mg administered once daily. Its efficacy as antihypertensive is superior to placebo and comparable to other first-line drugs.[1] Its well-known adverse effects are dizziness, gastrointestinal (GI) disturbances, and rarely headache.[2] The following reviews a patient who presented with headache, one of the rare side effects of telmisartan.
| Case History | | |
A 48-year-old male a known case of hypertension for the last 2 years and was on tablet amlodipine 10 mg once daily during the night for the last 2 years. He was referred to our hospital in view of uncontrolled hypertension. In addition to Tab amlodipine, he was started on tablet telmisartan 40 mg OD after breakfast. He came after 4 days with the complaint of diffuse intermittent headache for the last 4 days, which was affecting his day-to-day activity. His three consecutive blood pressures taken 30 min apart in this visit were within normal limits. After a careful review of medications and reviewing history for hypotension episode which was not present, tablet telmisartan was stopped and he was started on tablet atenolol 50 mg OD. Headache resolved after 2 days of stopping the tablet telmisartan and no similar episodes of headache were reported during the subsequent follow-up visits; also blood pressure was under control with this combination of anti-hypertensive medication.
| Discussion | | |
Hypertension (HTN) is one of the leading causes of increased risk of cardiovascular diseases.
“The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) define HTN stages as:
Normal blood pressure (BP): systolic BP is less than 120, and diastolic BP is less than 80.
Elevated BP: systolic BP 120 to 130 and diastolic BP is less than 80.
Stage 1 HTN: systolic BP 130 to 139 or diastolic BP 80 to 89.
Stage 2 HTN: systolic BP at least 140 or diastolic at least 90.
Hypertensive crises: systolic BP over 180 and/or diastolic BP over 120.”
There are different classes of drugs that are used in the treatment of hypertension. Some classes of drugs not only help in controlling high blood pressure but also decrease morbidity and mortality related to hypertension. First-line low-dose thiazides reduce all morbidity and mortality outcomes in adult patients with primary hypertension. First-line angiotensin-converting enzyme (ACE) inhibitors and calcium channel blocker may be similarly effective, but the evidence was of lower quality. First-line high-dose thiazides and first-line beta-blockers were inferior to first-line low-dose thiazides.[3],[4]
Telmisartan is an angiotensin II receptor antagonist used in the treatment of hypertension.[4] It is considered as first-line drug in the treatment of hypertension and is one of the most common medications used for hypertension management. It is one of the safest drugs for hypertension. Side effects are uncommon but may include dizziness, headache, fatigue, gastrointestinal upset, and fetal toxicity. Many angiotensin receptor blockers including telmisartan have been linked to rare cases of severe sprue-like enteropathy.[5] In our case using Naranjo Adverse Drug Reaction Probability Scale the score was 4, suggesting that telmisartan was the possible cause of the headache.[6] These side effects are not very common but awareness can help in timely intervention and better management of the patient.
| Conclusion | | |
Telmisartan is a very common drug prescribed for hypertension; its side effect like headache is not very common, but awareness can prevent unnecessary investigation and can decrease patient’s morbidity.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | McClellan KJ, Markham A Telmisartan. Drugs 1998;56:1039-44; discussion 1045-6.  |
| 2. | Smith DH, Matzek KM, Kempthorne-Rawson J Dose response and safety of telmisartan in patients with mild to moderate hypertension. J Clin Pharmacol 2000;40:1380-90. |
| 3. | Khalil H, Zeltser R Antihypertensive medications. [Updated 2021 Jul 26]. In: StatPearls [Internet] Treasure Island, FL: StatPearls Publishing; 2022. |
| 4. | PubChem [Internet]. Bethesda, MD: National Library of Medicine (US), National Center for Biotechnology Information; 2004. PubChem Compound Summary for CID 65999, Telmisartan. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/Telmisartan. [Last accessed on 2021 Sept 2]. |
| 5. | Bulsara KG, Cassagnol M Amlodipine. [Updated 2021 Aug 8]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022. |
| 6. | Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45. |
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