The Impact of Telmisartan on Inflammation and Oxidative Stress in Human Studies and Murine Models: A Narrative Review
Abstract
Chronic inflammation and oxidative stress play a critical role in conditions such as atherosclerosis, metabolic syndrome, and diabetic nephropathy. Telmisartan is a unique long-acting ARB due to its dual mechanism of action. In addition to blocking the AT1R, it acts as a partial agonist for peroxisome proliferator-activated receptor-gamma (PPAR-γ). It is also characterized by high lipophilicity compared to other drugs in its class, facilitating tissue penetration into the central nervous system. The objective of this narrative review is to bridge the gap between murine models of oxidative stress and inflammation and human clinical outcomes across the cardiovascular, renal, hepatic, neurological, and autoimmune systems. Across extensive human clinical trials and murine models, telmisartan demonstrates unique potential as a multi-system anti-inflammatory and antioxidant agent that actively suppresses pro-apoptotic and fibrotic cascades. Beyond these systemic effects, telmisartan confers localized vascular benefits by actively stabilizing coronary plaques and suppressing cardiac inflammation. While its cardiovascular and renal benefits are the most widely investigated, it also demonstrates profound extra-cardiac efficacy. In particular, telmisartan improves neuroinflammation in neurodegenerative diseases, metabolic profiles in hepatic steatosis, and protects against gastrointestinal and musculoskeletal inflammation. But its protective effects are limited for established HIV fibrosis and severe primary autoimmune conditions like psoriasis. In conclusion, telmisartan is a cardiometabolic and immunomodulatory drug, extending the clinical use beyond hypertension.
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[2] Pawlonka J, Buchalska B, Buczma K, Borzuta H, Kamińska K, Cudnoch-Jędrzejewska A. Targeting the Renin-angiotensin-aldosterone System (RAAS) for Cardiovascular Protection and Enhanced Oncological Outcomes: Review. Curr Treat Options Oncol. 2024; 25(11):1406-1427.
[3] Siragy H. Angiotensin II receptor blockers: review of the binding characteristics. Am J Cardiol. 1999; 84(10A):3S-8S.
[4] Eguchi S, Kawai T, Scalia R, Rizzo V. Understanding Angiotensin II Type 1 Receptor Signaling in Vascular Pathophysiology. Hypertension. 2018; 71(5):804-810.
[5] Weinberg Sibony R, Segev O, Dor S, Raz I. Overview of oxidative stress and inflammation in diabetes. J Diabetes. 2024; 16(10):e70014.
[6] Masenga SK, Kabwe LS, Chakulya M, Kirabo A. Mechanisms of Oxidative Stress in Metabolic Syndrome. Int J Mol Sci. 2023; 24(9):7898.
[7] Nzobokela J, Muchaili L, Mwambungu A, Masenga SK, Kirabo A, et al. Pathophysiology and emerging biomarkers of cardiovascular-renal-hepato-metabolic syndrome. Front Cardiovasc Med. 2025; 12:1661563.
[8] Ernsberger P, Koletsky RJ. Metabolic actions of angiotensin receptor antagonists: PPAR-gamma agonist actions or a class effect? Curr Opin Pharmacol. 2007; 7(2):140-5.
[9] Ayza MA, Zewdie KA, Tesfaye BA, Gebrekirstos ST, Berhe DF. Anti-Diabetic Effect of Telmisartan Through its Partial PPARγ-Agonistic Activity. Diabetes Metab Syndr Obes. 2020; 13:3627-3635.
[10] Araújo AA, Souza TO, Moura LM, Brito GA, Aragão KS, Araújo LS, et al. Effect of telmisartan on levels of IL-1, TNF-α, down-regulated COX-2, MMP-2, MMP-9 and RANKL/RANK in an experimental periodontitis model. J Clin Periodontol. 2013; 40(12):1104-11.
[11] Cianchetti S, Del Fiorentino A, Colognato R, Di Stefano R, Franzoni F, Pedrinelli R. Anti-inflammatory and anti-oxidant properties of telmisartan in cultured human umbilical vein endothelial cells. Atherosclerosis. 2008; 198(1):22-8.
[12] Li W, Zhang JW, Lu F, Ma MM, Wang JQ, Suo AQ, et al. [Effects of telmisartan on the level of Aβ1-42, interleukin-1β, tumor necrosis factor α and cognition in hypertensive patients with Alzheimer's disease]. Zhonghua Yi Xue Za Zhi. 2012; 92(39):2743-6. Chinese.
[13] Tsukuda K, Mogi M, Iwanami J, Min LJ, Sakata A, Jing F, et al. Cognitive deficit in amyloid-beta-injected mice was improved by pretreatment with a low dose of telmisartan partly because of peroxisome proliferator-activated receptor-gamma activation. Hypertension. 2009; 54(4):782-7.
[14] Arozal W, Watanabe K, Veeraveedu PT, Ma M, Thandavarayan RA, Sukumaran V, et al. Telmisartan prevents the progression of renal injury in daunorubicin rats with the alteration of angiotensin II and endothelin-1 receptor expression associated with its PPAR-γ agonist actions. Toxicology. 2011; 279(1-3):91-9.
[15] Dessì M, Madeddu C, Piras A, Cadeddu C, Antoni G, Mercuro G, et al. Long-term, up to 18 months, protective effects of the angiotensin II receptor blocker telmisartan on Epirubin-induced inflammation and oxidative stress assessed by serial strain rate. Springerplus. 2013; 2(1):198.
[16] Dessì M, Piras A, Madeddu C, Cadeddu C, Deidda M, Massa E, et al. Long-term protective effects of the angiotensin receptor blocker telmisartan on epirubicin-induced inflammation, oxidative stress and myocardial dysfunction. Exp Ther Med. 2011; 2(5):1003-1009.
[17] Ibrahim MA, Ashour OM, Ibrahim YF, El-Bitar HI, Gomaa W, Abdel-Rahim SR. Angiotensin-converting enzyme inhibition and angiotensin AT(1)-receptor antagonism equally improve doxorubicin-induced cardiotoxicity and nephrotoxicity. Pharmacol Res. 2009; 60(5):373-81.
[18] Malik S, Suchal K, Gamad N, Dinda AK, Arya DS, Bhatia J. Telmisartan ameliorates cisplatin-induced nephrotoxicity by inhibiting MAPK mediated inflammation and apoptosis. Eur J Pharmacol. 2015; 762:488.
[19] Arab HH, Al-Shorbagy MY, Abdallah DM, Nassar NN. Telmisartan attenuates colon inflammation, oxidative perturbations and apoptosis in a rat model of experimental inflammatory bowel disease. PLoS One. 2014; 9(5):e97193.
[20] Guerra GC, Araújo AA, Lira GA, Melo MN, Souto KK, Fernandes D, et al. Telmisartan decreases inflammation by modulating TNF-α, IL-10, and RANK/RANKL in a rat model of ulcerative colitis. Pharmacol Rep. 2015; 67(3):520-6.
[21] Hong SJ, Shim WJ, Choi JI, Joo HJ, Shin SY, Park SM, et al. Comparison of effects of telmisartan and valsartan on late lumen loss and inflammatory markers after sirolimus-eluting stent implantation in hypertensive patients. Am J Cardiol. 2007; 100(11):1625-9.
[22] Porto I, Di Vito L, De Maria GL, Dato I, Tritarelli A, Leone AM, et al. Comparison of the effects of ramipril versus telmisartan on high-sensitivity C-reactive protein and endothelial progenitor cells after acute coronary syndrome. Am J Cardiol. 2009; 103(11):1500-5.
[23] Satoh M, Tabuchi T, Minami Y, Takahashi Y, Itoh T, Nakamura M. Prospective, randomized, single-blind comparison of effects of 6 months of treatment with telmisartan versus enalapril on high-molecular-weight adiponectin concentrations in patients with coronary artery disease. Clin Ther. 2009; 31(10):2113-25.
[24] Yamaguchi K, Wakatsuki T, Soeki T, Niki T, Taketani Y, Oeduka H, et al. Effects of telmisartan on inflammatory cytokines and coronary plaque component as assessed on integrated backscatter intravascular ultrasound in hypertensive patients. Circ J. 2014; 78(1):240-7.
[25] Takaya T, Kawashima S, Shinohara M, Yamashita T, Toh R, Sasaki N, et al. Angiotensin II type 1 receptor blocker telmisartan suppresses superoxide production and reduces atherosclerotic lesion formation in apolipoprotein E-deficient mice. Atherosclerosis. 2006; 186(2):402-10.
[26] Blessing E, Preusch M, Kranzhöfer R, Kinscherf R, Marx N, Rosenfeld ME, et al. Anti-atherosclerotic properties of telmisartan in advanced atherosclerotic lesions in apolipoprotein E deficient mice. Atherosclerosis. 2008; 199(2):295-303.
[27] Nakagami H, Osako MK, Takami Y, Hanayama R, Koriyama H, Mori M, et al. Differential response of vascular hepatocyte growth factor concentration and lipid accumulation between telmisartan and losartan in ApoE-deficient mice. Mol Med Rep. 2008; 1(5):657-61.
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| Files | ||
| Issue | Vol 12 No 5 (2026): Sept-Oct |
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| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v12i5.22437 | |
| Keywords | ||
| Angiotensin II type 1 receptor blockers Telmisartan Inflammation Oxidative stress Immunomodulation PPAR gamma | ||
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How to Cite
1.
Karbasforoushan A, Samimi S, Sanatkar M, Alikarami S. The Impact of Telmisartan on Inflammation and Oxidative Stress in Human Studies and Murine Models: A Narrative Review. Arch Anesth & Crit Care. 2026;12(5):539-549.
