Brief Answer: You should undergo further radiologic examinations and laboratory exams. You should be guided by an internal medicine doctor. Detailed answer: Thank you for using HCM. I understand your concern. First of all, more than a therapeutic approach, I would suggest you to undergo further radiologic examinations, and laboratory exams, in way to detect any possible cause of your high blood pressure. Your age is too young and your blood pressure levels under treatment, are still high (148/95mmHg) , to have an essential (primary) hypertension. You should be screened for all the secondary possible causes of hypertension such as renal stenosis , renal parenchymal disease , Cushing syndrome , Pheocromocitoma, Hyperaldosteronism, Hyperthyroidism, Sleep apnea, Acromegaly, Coartation of aorta etc. For excluding each of them , you need to do a series of laboratory and imaging exams . The internist is the adequate doctor which may lead you in detecting the causing factor of your hypertension. It seems a little bit long way to do , but i encourage you to go under it , cause treating the causing factor once is better than treating hypertension for all of your life. There are even cases in which eventhough you do all tests for secondary causes , it doesn t get out nothing. At this case we are in front of an idiopathic hypertension , which we have to deal with. Regarding to your actual treatment, Telmisartan is a good choice. Most of the antihypertensive effect of Telmisartan is apparent within 2 weeks. But is difficult to deduct if you have a good response to this drug or not by measuring the blood pressure only one time a month. You should monitor the blood pressure at least three times a day for one week , to see the range of your blood pressure values during a normal week. If you have a persistent blood pressure higher than 140/90 mmHg, additional blood pressure reduction should be achieved, increasing the Telmisartan dosage to 80 mg. Meanwhile, you should do effective lifestyle changes for controlling blood pressure, such as : weight loss , regular physical activity — at least 30 minutes 3 days of the week, eating a diet that is rich in whole grains, fruits, vegetables and low-fat dairy products. You should restrict the salt quantity that you take with food. Try to avoid alcohol, smoking, and caffeine. Try not to get stressed. Hope this is helpful. Let me know if you need more clarifications. Otherwise please close and rate the answer. Kind Regards, Dr. Juarda