Telmisartan, a humble blood pressure medication or is there more?
Why is telmisartan, a blood pressure medication of interest for neurocognitive decline? Optimal blood pressure (BP) is ~115/75 mmHg for most individuals. So if one has a BP greater than this, or is on another medication for blood pressure and doesn’t have a reason not to be on this medication, in the longevity arena, it seems to be the drug of choice.
Telmisartan appears to improve insulin sensitivity, mitochondrial activity, and endothelial function. Drugs in this class are called Angiotensin II Receptor Blockers, or ARBs. However, telmisartan is unique, in regard to its effect on the brain, primarily at the 80-160 mg daily dose.
Specifically, the ONTARGET trial allowed the health claim that this medication reduces heart attack, stroke and death from cardiovascular disease. ONTARGET Trial (Click on this)
In regard to the brain, telmisartan exerts a potent activation of peroxisome proliferator-activated receptor gamma (PPAR-Ɣ) with telmisartan being at least 10 times more potent than other ARBs in this effect.
It appears likely that high doses are needed to get the maximal benefit - which also may relate to more favorable outcomes both cognitively and metabolically. At least 80 mg, and possibly 160 mg may be needed. These higher doses, typically don’t have much effect on blood pressure as compared to more modest doses of telmisartan in most patients.
Significant components of benefit with medications shown to decrease neurocognitive decline relate to their ability to treat components of metabolic syndrome, particularly insulin sensitivity in the brain. This article relates to the benefits of this drug for metabolic syndrome.
This review details that brain penetrating drugs in this class, such as telmisartan, seem to result in decreased rates of cognitive decline.
On a more technical level, the Journal of Neuroinflammation looked at effects of telmisartan and concluded telmisartan “should be considered for the treatment of inflammatory conditions of the brain.”
Furthermore, if you happen to be a hypertensive rat, there is hope - also significantly through the PPAR-Ɣ pathway and through a couple of other pathways, but irrespective, is protective against cognitive decline.
In regard to Alzheimer’s Disease (AD), there are multiple published studies looking at this issue, there are links to these below. The conclusion is that this drug is likely preventive of AD and may even improve outcomes once established. Many studies are on animal models, some based on population outcomes of humans. The second article below claims a 30% decreased rate of dementia in humans. The fourth article looks at a combination of rosuvastatin with telmisartan.
In the mouse model of Parkinson’s Disease (PD), there is evidence of neuroprotection of the cells that generate dopamine, and also evidence of neuroprotection. They concluded that “PPAR-γ activation is involved in the anti-inflammatory and neuroprotective effects of AT1 deletion.”
So the conclusion is that we don’t have a great trial showing disease modifying effects, or decreased likelihood of ever having a diagnosis of AD or PD with Telmisartan. We however have a great deal of suggestive evidence. This is a uniquely beneficial agent, and as such, IF you are in need of medication to optimize your blood pressure, it seems like an excellent first choice or at least as part of your anti-hypertensive regimen. If you are going to take a drug for BP, why not go for one that might decrease risk of neurocognitive decline?
Disclaimer:
This blog provides general education only and should not be used to diagnose or replace the advice of a qualified medical professional.
This content is not intended to be a substitute for consultation with a qualified and licensed physician or another medical provider.
Readers should consult a medical professional for advice, diagnosis and treatment relating to their individual case.
You should discuss any supplement/medication being considered with your medical professional before starting it.
Monthly Newsletter
Sign up to receive updates from our research, success stories, and upcoming events.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
