A blood pressure reading of 200/100 mmHg is very high and needs urgent medical attention, even if you are taking Telma 40 mg Tablet (Telmisartan). This can happen for several reasons. The dose of this medicine may not be sufficient for you, or you may need an additional blood pressure medicine. Missing doses, taking too much salt, stress, obesity, kidney disease, hormonal problems, or certain medicines such as painkillers and decongestants can also make blood pressure difficult to control. Sometimes blood pressure remains high despite treatment because of an underlying medical condition that needs further evaluation. Do not increase the dose or stop your medicine on your own. Since your blood pressure is extremely high, please visit the nearest emergency department or contact your doctor immediately, especially if you have a headache, chest pain, shortness of breath, dizziness, or changes in vision.