Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2026 09 05 539 549 Ali Karbasforoushan Department of Cardiology, Zanjan University of Medical Sciences, Zanjan, Iran. Saghar Samimi Department of Anesthesiology and Critical Care and Pain, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahsa Sanatkar Department of Biotechnology, Tehran University of Medical Sciences, Tehran, Iran. Sogol Alikarami Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2026 08 19 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. https://aacc.tums.ac.ir/index.php/aacc/article/view/1720