Positives

• Cardiologists writing about Long COVID highlight telmisartan as an AT1R-antagonist that may re-establish cardiovascular homeostasis after SARS-CoV-2 downregulates ACE2, addressing microvascular angina, arrhythmias, and blood pressure abnormalities PMC.
  
  
• In an open multicenter randomized trial in COVID-19 patients, day-30 mortality was reduced from 22.54% in controls to 4.29% in the telmisartan group with no reported adverse events PMC.
  
  

Negatives

• A phase IIb trial in mild to moderate COVID-19 found atorvastatin and telmisartan did not reduce nasopharyngeal SARS-CoV-2 carriage, tempering enthusiasm for direct antiviral effect Nature.
  
  

Hurdles & Side Effects

• Telmisartan can cause first-dose hypotension and orthostatic dizziness, which is a particular problem for Long COVID patients with comorbid POTS who already struggle with low standing blood pressure Standinguptopots.