In this video, Deb and Mike discuss a question about where a person with no photography skills can go in Kakadu to capture a stunning image.
Mike explains that the answer depends on the specific image they are after, as lighting and location play crucial roles. He emphasizes that there is no right or wrong time of day or location for photography in Kakadu.
However, Deb, having a photography background, suggests that the best time of day for photography is sunrise or sunset, during the golden hour. She recommends Ubirr Rock in the north of Kakadu as an iconic location with breathtaking sunsets over the floodplains.
Dan and Neville also discuss the same question, and Neville mentions that the choice of location depends on the person’s preferences. They discuss various options like helicopter rides, lookout points, and specific spots like Nawurlandja and Ubirr with opportunities for capturing storms, lightning, and different times of the day.
Dan even humorously suggests taking a photo of himself in front of a work vehicle.
Lastly, Leigh and Yvonne agree that Ubirr at sunset is a stunning location for photography, with its 360-degree views, vibrant colours, wetland area, and escarpment in the background. They emphasize that one doesn’t need to be an expert to capture a good photo there.
This edition – Katherine Gorge or Kakadu? Insta-worthy places in Litchfield. How long do you need in Kakadu, & more.
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This edition – Katherine Gorge or Kakadu? Insta-worthy places in Litchfield. How long do you need in Kakadu, & more.
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Telmisartan: A Doctor’s Review for Australians Over 30
By a practising Australian GP
Attention: The Silent Problem Affecting One in Three Australians
If you are over 30, there is a one in three chance you have high blood pressure. Many people feel completely well while their blood pressure quietly damages the heart, brain, kidneys and eyes. In my clinic, I regularly see patients who want to take control but struggle with current tablets. The most common complaint? A dry, irritating cough caused by older blood pressure medicines called ACE inhibitors, such as perindopril, ramipril or enalapril. Some patients feel so miserable they stop treatment altogether, putting themselves at risk of heart attack and stroke.
There is a modern, well-researched alternative: telmisartan. This article explains why telmisartan is a first-choice option for many Australians over 30, especially if you have had a cough, worry about kidney or liver health, have diabetes risk, or use salt substitutes.
Interest: How Telmisartan Works
Telmisartan belongs to a class called angiotensin II receptor blockers (ARBs). It blocks the hormone angiotensin II, which normally narrows blood vessels and raises blood pressure. By blocking this hormone at the receptor, telmisartan allows blood vessels to relax and widen, lowering blood pressure smoothly.
Unlike ACE inhibitors, telmisartan does not increase bradykinin, a substance that can trigger the infamous dry cough. This is why telmisartan is so well tolerated.
Telmisartan vs ACE Inhibitors: Cough and Tolerability
Feature
ACE inhibitors (e.g. perindopril, ramipril)
Telmisartan
Dry cough
Common (up to 20% of patients)
Rare, similar to placebo
Angioedema (swelling of face/airway)
Rare but serious
Much rarer
Duration of action
Variable, may need twice-daily dosing
Half-life about 24 hours, once-daily dosing
Effect on insulin sensitivity
Generally neutral
Improves insulin sensitivity
Main route of elimination
Often significant kidney excretion
Mainly liver/biliary; minimal kidney excretion
Metabolism and Excretion: Why It Is Gentler on the Kidneys
Telmisartan is metabolised in the liver by glucuronidation and is excreted almost entirely through bile into the faeces. Less than 1% of the drug is eliminated unchanged in the urine. This is important: patients with reduced kidney function or those on dialysis are less likely to accumulate the drug. The long half-life of about 24 hours means telmisartan provides consistent blood pressure control through the day and night, including the early-morning surge when heart attacks and strokes are most common.
Clinical Studies: Strong Evidence for Heart and Brain Protection
Telmisartan is not just a blood pressure pill. Large international trials have proven its cardiovascular benefits.
Study
Population
Key Finding
ONTARGET
25,620 people with high cardiovascular risk
Telmisartan was as effective as ramipril in reducing cardiovascular death, heart attack, stroke and heart failure, but with fewer coughs and better tolerability.
TRANSCEND
People who could not tolerate ACE inhibitors
Telmisartan reduced cardiovascular events compared with placebo, offering a safe alternative for ACE-intolerant patients.
PRoFESS
Recent stroke patients
Confirmed blood pressure lowering and secondary prevention role.
Desire: The Metabolic and Practical Advantages
Telmisartan and Insulin Sensitivity
Many Australians over 30 struggle with weight gain, prediabetes or type 2 diabetes. Telmisartan is unique among ARBs: it partially activates PPAR-gamma, a receptor involved in glucose and fat metabolism. Studies show telmisartan improves insulin sensitivity, lowers fasting insulin levels, and may reduce the risk of new-onset diabetes. This makes it an excellent choice if you have high blood pressure plus metabolic syndrome, prediabetes, or a family history of type 2 diabetes.
Telmisartan and Salt Substitutes
Many patients try to lower blood pressure by using salt substitutes. In Australia, these products often replace sodium chloride with potassium chloride. While reducing sodium is good, the extra potassium can be dangerous when combined with telmisartan or other blood pressure medicines that affect potassium balance. Excess potassium can cause irregular heart rhythms and cardiac arrest. Important: If you take telmisartan, avoid potassium-based salt substitutes unless your doctor has checked your potassium levels and given approval. Use herbs, garlic, lemon juice, pepper and spices to flavour food instead.
Telmisartan Dosing in Dialysis Patients
Patients on dialysis still need blood pressure control and heart protection. Telmisartan is highly protein-bound and is not significantly removed by haemodialysis. It can be used in dialysis patients, but doctors usually start with a low dose of 20 mg once daily and monitor blood pressure and potassium carefully. Because it is minimally excreted by the kidneys, drug accumulation is less of a concern than with many other blood pressure medications.
Telmisartan and Hepatic Impairment Dosing
Because telmisartan is cleared mainly by the liver, dose adjustment is necessary in liver disease. In mild to moderate hepatic impairment, the maximum recommended dose is 40 mg once daily. Telmisartan should not be used in severe liver disease or biliary obstruction. Always tell your doctor about any history of liver problems.
Telmisartan Authority Prescription Australia
In Australia, telmisartan is available through the Pharmaceutical Benefits Scheme (PBS). It is prescribed under streamlined authority for hypertension. This means your GP can prescribe it easily without complex paperwork when you meet the PBS criteria—commonly when an ACE inhibitor has caused cough or intolerance. This makes telmisartan affordable and accessible for most Australians. It is also available on private prescription if required.
Dosing at a Glance
Clinical Situation
Dosing Advice
Standard starting dose
40 mg once daily, may increase to 80 mg once daily
ACE inhibitor cough
Switch to telmisartan 40 mg once daily after stopping ACE inhibitor
Mild–moderate liver disease
Maximum 40 mg once daily
Severe liver disease / biliary obstruction
Do not use
Dialysis patients
Start 20 mg once daily, monitor potassium
Using potassium salt substitutes
Avoid them; monitor serum potassium
Action: Take the Next Step Today
Telmisartan offers 24-hour blood pressure control, proven heart and brain protection, a low risk of cough, kidney-friendly metabolism, and a unique metabolic benefit for insulin sensitivity. If you are over 30 and living with high blood pressure, or if your current blood pressure medicine causes a cough, it may be time to talk to your GP about telmisartan.
Your next steps:
Book an appointment with your GP to review your blood pressure medicines.
Ask: “Is telmisartan suitable for me?”
If you have a dry cough on an ACE inhibitor, mention switching to telmisartan.
Bring a list of your current medicines, including any salt substitutes or over-the-counter products.
Ask for a blood test to check your kidney function and potassium before and after starting.
Don’t let a cough or outdated medication stop you from protecting your heart and brain. Telmisartan could be the change that makes your blood pressure treatment finally easy to live with.
This article is for general educational information and is not a substitute for individual medical advice. Always consult your GP or specialist before starting, changing or stopping any medication.
