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Stakeholder Insight: Hypertension - Multiple Layers of Therapy Cover all EventualitiesPublished by: Datamonitor Published: Dec. 19, 2005 - 265 Pages Table of ContentsTABLE OF CONTENTS 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 AbstractIntroductionHypertension 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 Get Full Details About This Report >> |
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