Telmisartan is an angiotensin II receptor blocker with partial PPAR-gamma agonist activity — a thiazolidinedione-like effect on insulin sensitivity.
Mechanism — Standard ARB effects (vasodilation, reduced aldosterone) plus PPAR-gamma activation in adipose and muscle tissue, improving insulin sensitivity and lipid profile.
Use case — Hypertensive patients with metabolic syndrome or pre-diabetes. The 'metabolic ARB.' Typical 40-80 mg/day. Long half-life (~24 hr) supports once-daily dosing.
Caveats — Same class precautions as losartan. The PPAR-gamma effect is modest — don't treat metabolic syndrome with telmisartan alone. Often the choice when an ARB is indicated AND metabolic improvement is desired.