Does Telmisartan Lower Heart Rate?

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Does Telmisartan Lower Heart Rate?

By Your Health Magazine Health Information Team

Usually, no. Telmisartan lowers blood pressure but does not normally lower heart rate. It relaxes blood vessels by blocking the effects of angiotensin II, a substance that narrows blood vessels. In controlled clinical trials, people treated with telmisartan did not have meaningful changes in heart rate. If your pulse becomes noticeably slower after starting telmisartan, another medication, an underlying health condition, or an unusually low blood pressure may be involved.

How Telmisartan Affects Blood Pressure and Heart Rate

Telmisartan is an angiotensin II receptor blocker, commonly called an ARB. Its active ingredient is telmisartan, and it is supplied as an oral tablet. It has also been sold under the brand name Micardis. Telmisartan is primarily prescribed to treat high blood pressure and, in certain high-risk adults who cannot take an ACE inhibitor, to reduce cardiovascular risk.

Blood pressure and heart rate measure different things:

Telmisartan does not directly slow the heart’s electrical signals in the way certain beta blockers and some calcium channel blockers can. The current DailyMed prescribing information for telmisartan reports that controlled trials found no changes in the heart rate of treated patients.

Why Might Heart Rate Decrease While Taking Telmisartan?

Although telmisartan is not considered a heart-rate-lowering medication, a slower pulse can occur for reasons unrelated or indirectly related to treatment. Possibilities include:

• Other medications: Beta blockers, some calcium channel blockers, and certain medicines used for abnormal heart rhythms can reduce heart rate.
• Low blood pressure: Telmisartan can occasionally lower blood pressure enough to cause dizziness, weakness, or faintness, especially in someone who is dehydrated or taking a diuretic.
• Dehydration or illness: Vomiting, diarrhea, heavy sweating, fever, or inadequate fluid intake can affect blood pressure and pulse.
• Normal variation: Heart rate commonly decreases during sleep. Physically active people may also have a resting pulse below 60 beats per minute without having a medical problem.
• An underlying condition: Thyroid disorders, electrolyte imbalances, sleep apnea, heart conduction problems, and other conditions can cause a slow heart rate.

Telmisartan overdose is a different situation. The prescribing information indicates that severe hypotension, dizziness, and a fast heartbeat are more likely, although a slow heartbeat could also occur. A suspected overdose requires immediate assistance from Poison Control or emergency services.

How Telmisartan Differs From Heart-Rate-Lowering Medicines

Telmisartan may reduce how hard the heart must work against narrowed blood vessels, but that does not mean it directly reduces the number of beats per minute. A beta blocker, by comparison, can slow heart rate by reducing the effects of stress hormones on the heart.

Losartan is another ARB that generally lowers blood pressure without directly slowing the pulse. Readers comparing ARBs may also find this discussion of whether losartan can help lower heart rate useful.

Check the active ingredients on your prescription label. A combination tablet may contain telmisartan plus another blood pressure medicine, and the added ingredient may have different effects. A pharmacist can confirm whether your specific product contains telmisartan alone or multiple medications.

What to Do If Your Pulse Seems Lower

One unusual reading does not necessarily indicate a problem. To check your resting pulse, sit quietly for several minutes, place your index and middle fingers over the artery on the thumb side of your wrist, and count the beats for 60 seconds. The American Heart Association’s heart-rate guidance explains that a typical resting heart rate for a calm adult is 60 to 100 beats per minute, although healthy exceptions are common.

If you notice a change, record:

• Your heart rate and blood pressure
• The time of day and whether you were resting
• Any dizziness, weakness, breathlessness, chest discomfort, or faintness
• When you took telmisartan and your other medications
• Recent vomiting, diarrhea, heavy sweating, illness, or reduced fluid intake

Share repeated readings with your prescribing clinician. Do not change or stop telmisartan or another prescription medicine on your own. A clinician may review your medication list, check blood pressure while sitting and standing, order blood tests, or perform an electrocardiogram when appropriate.

Important Telmisartan Safety Considerations

Telmisartan can cause dizziness, lightheadedness, or fainting when blood pressure falls too low. It can also affect kidney function and potassium levels. Potassium supplements, potassium-containing salt substitutes, nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen, and certain other prescriptions may require special caution or monitoring.

Telmisartan carries a fetal toxicity warning and generally should not be used during pregnancy. Anyone who becomes pregnant while taking it should contact the prescribing healthcare professional immediately. The MedlinePlus telmisartan guide provides additional information about precautions, interactions, and possible side effects. Information about other prescriptions is available through the MedlinePlus drug information directory.

When to Seek Care

Contact your healthcare professional if your resting heart rate is repeatedly slower than usual, particularly if the change began after starting a medication or is accompanied by fatigue, dizziness, weakness, or reduced exercise tolerance. A primary care clinician, cardiologist, or pharmacist can help review possible medication and health-related causes.

Call 911 for a suddenly very low or very high heart rate accompanied by chest pain, shortness of breath, confusion, fainting, severe weakness, or other signs that something is seriously wrong. Swelling of the face, lips, tongue, or throat or difficulty breathing may indicate a severe allergic reaction and also requires emergency care.

The bottom line: Telmisartan is intended to lower blood pressure, not heart rate. Most people should not expect a significant pulse reduction from telmisartan alone. A new, persistent, or symptomatic slow heart rate deserves medical evaluation rather than an unsupervised medication change.