Introduction
Hypertension is a deadly disease and an important global public health challenge. Datamonitor estimates that there are currently 192m people with hypertension in the seven major markets, and this number is set to rise to 212m by 2015. Yet, a significant fraction of this sizeable patient pool remains undiagnosed or aborts treatment, considerably limiting the size of the market.
Scope
- Analysis of diagnosis, treatment and blood pressure control rates for the hypertensive population
- Assessment of the extent to which physicians treat sub-populations differently
- Examination of the use of combination therapy, drug classes and brands across the hypertensive sub-populations
- Evaluation of future prescribing trends and the potential of novel antihypertensive therapies
Highlights
There is a significant proportion of patients who drop out of antihypertensive therapy prematurely. These therapy drop-outs substantially limit market size. To reduce concomitant loss of potential revenue, drug manufacturers must sustain aggressive awareness campaigns designed to help patients understand that hypertension is a deadly disease.
There is space for novel antihypertensive therapies in the hypertension market. The overwhelming majority of patients are receiving multiple layers of therapy to control their hypertension, but combination therapy does not sit well with many patients, as the drugs are costly and often have side effects.
Physicians are generally aware of developmental antihypertensive therapies but appear reluctant to administer them to their own consulting population.
Reasons to Purchase
- Identify the most lucrative target niche populations for developmental products
- Understand how to position new antihypertensive therapies
- Gain insight into prescribing patterns and physician opinions on current treatment paradigms
CHAPTER 1 EXECUTIVE SUMMARY 3
Scope of the analysis 3
Datamonitor insight into the hypertension market 4
Greater awareness and education of hypertension is required 5
Inhibitors of the renin-angiotensin system (RAS) are the number one choice for the treatment of hypertension at any line of therapy 6
There is space for novel antihypertensive therapies in the hypertension market 8
Datamonitor conclusions 9
CHAPTER 2 INTRODUCTION AND SCOPE 17
Coverage of the Stakeholder Insight Survey 18
CHAPTER 3 COUNTRY TREATMENT TREES 21
Introduction to the treatment trees 21
US 23
Japan 27
France 31
Germany 35
Italy 39
Spain 43
UK 47
CHAPTER 4 EPIDEMIOLOGY OF HYPERTENSION 51
Definition of hypertension 51
Prevalence of hypertension in the US 51
Prevalence of hypertension in Japan 53
Prevalence of hypertension in France 54
Prevalence of hypertension in Germany 55
Prevalence of hypertension in Italy 56
Prevalence of hypertension in Spain 57
Prevalence of hypertension in the UK 58
Prevalence of hypertension across the seven major markets 59
CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS 62
Diagnosis rates 65
Segmentation of hypertensive patients 68
Diabetic hypertensive patients 68
Hypertensives with renal disease 69
Isolated systolic hypertension 71
Breakdown of disease severity 75
Prevalence of conditions comorbid to hypertension 77
Target SBP for diabetic hypertensives 79
Treatment rates 85
CHAPTER 6 OVERALL PRESCRIBING TRENDS 87
Overall prescribing trend not dominated by any one class 87
Angiotensin converting enzyme inhibitors 91
Angiotensin II receptor blockers 93
Beta blockers 95
Calcium channel blockers 98
Diuretics 100
Combination therapy 103
Proportion of patients receiving combination drug therapy 103
Total hypertensive patients 105
Diabetic hypertensives 110
Non-diabetic hypertensive patients with renal disease 113
Patients with isolated systolic hypertension 115
Hypertensives of African descent 117
Use of single-pill combination therapy 119
Resistant hypertension 122
CHAPTER 7 FIRST- TO SECOND-LINE THERAPY 125
First-line therapy 125
Breakdown of antihypertensive first-line therapy by drug class 125
ACE inhibitors 129
Beta blockers 129
Angiotensin II receptor blockers 130
Calcium channel blockers 130
Diuretics 130
Second-line therapy 133
Breakdown of antihypertensive second-line therapy by drug class 134
ACE inhibitors: first versus second line 136
Beta blockers 138
Angiotensin II receptor blockers 139
Calcium channel blockers 140
Diuretics 141
Breakdown of antihypertensive third-line therapy by drug class 142
Changes in antihypertensive therapy 143
Continuation and discontinuation of therapy 143
Type of change in antihypertensive therapy 147
Reasons for changes in antihypertensive therapy 148
CHAPTER 8 INDIVIDUAL PRODUCT ASSESSMENT 150
ACE inhibitors 150
Breakdown of ACE inhibitor use 151
Overall hypertensive population 152
Subpopulation differences 154
Branded versus generic ACE inhibitors 157
US 158
Japan 159
France 161
Germany 162
Italy 164
Spain 166
UK 168
Plain ACE inhibitor versus ACE inhibitor combinations 172
Angiotensin II receptor blockers 173
Breakdown of ARB use 174
Overall hypertensive population 174
Sub-population differences 177
Plain ARB versus ARB diuretic single-pill combinations 179
Key factors influencing ARB use in the future 182
Beta blockers 187
Breakdown of beta blocker use 187
Overall hypertensive population 187
Branded versus generic beta blockers 189
Calcium channel blockers 190
Breakdown of CCB use 190
Overall hypertensive population 190
Branded versus generic CCBs 194
Diuretics 195
Breakdown of diuretics inhibitor use 195
Overall hypertensive population 195
Branded versus generic diuretics 198
CHAPTER 9 FUTURE DEVELOPMENTS 200
Pipeline products 200
Olmesartan-HCTZ single-pill combination: Benicar HCT 200
Atorvastatin-amlodipine single-pill combination: Caduet 204
Enalapril-lercanidipine single-pill combination: Zanipress 208
Eplerenone: Inspra 211
S-amlodipine 214
Aliskiren (SPP-100) 217
Prescription drivers of the antihypertensive market 222
Efficacy and side-effect profile 224
Quality of life improvement 224
Use in niche populations 225
Number of additional indications upon launch 226
Marketing and pricing 226
Single-pill combinations: with diuretic, cross-risk factor and multi-modal drugs 228
APPENDIX A BIBLIOGRAPHY 230
References 230
Hypertension management guidelines 236
JNC 7 236
ESH/ESC 236
WHO/ISH 236
BHS-IV 236
APPENDIX B PRIMARY RESEARCH 237
Physician research methodology 237
Physician sample breakdown 237
US 237
Japan 238
France 238
Germany 239
Italy 239
Spain 240
UK 240
Questionnaire 241
Diagnosis 242
Treatment 246
ACE inhibitors 253
Angiotensin II receptor blockers (ARBs) 255
Diuretics 258
Calcium channel blockers 259
Beta blockers 260
Treatment outcomes 262
Future developments 263
Disclaimer 265
Other selected research from the 'Cardiovascular' category:
Stakeholder Insight: Hypertension - Multiple Layers of Therapy Cover all Eventualities
Diabetes, Metabolic Syndrome and Cardiovascular Disease
Other selected research from the 'Stakeholder Insight' category:
Stakeholder Insight: Prostate Cancer Treatment in the USA
Stakeholder Insight: Psoriasis - Biologics are yet to make topical treatments obsolete