Table of Contents
- ABOUT DATAMONITOR HEALTHCARE
- About the cardiovascular pharmaceutical analysis team
- CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Datamonitor insight into the hypertension market
- Greater awareness and education of hypertension is required
- Inhibitors of the renin-angiotensin system (RAS) are the number one
choice for the treatment of hypertension at any line of therapy
- There is space for novel antihypertensive therapies in the
hypertension market
- Datamonitor conclusions
- CHAPTER 2 INTRODUCTION AND SCOPE
- Coverage of the Stakeholder Insight Survey
- CHAPTER 3 COUNTRY TREATMENT TREES
- Introduction to the treatment trees
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
- CHAPTER 4 EPIDEMIOLOGY OF HYPERTENSION
- Definition of hypertension
- Prevalence of hypertension in the US
- Prevalence of hypertension in Japan
- Prevalence of hypertension in France
- Prevalence of hypertension in Germany
- Prevalence of hypertension in Italy
- Prevalence of hypertension in Spain
- Prevalence of hypertension in the UK
- Prevalence of hypertension across the seven major markets
- CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS
- Diagnosis rates
- Segmentation of hypertensive patients
- Diabetic hypertensive patients
- Hypertensives with renal disease
- Isolated systolic hypertension
- Breakdown of disease severity
- Prevalence of conditions comorbid to hypertension
- Target SBP for diabetic hypertensives
- Treatment rates
- CHAPTER 6 OVERALL PRESCRIBING TRENDS
- Overall prescribing trend not dominated by any one class
- Angiotensin converting enzyme inhibitors
- Angiotensin II receptor blockers
- Beta blockers
- Calcium channel blockers
- Diuretics
- Combination therapy
- Proportion of patients receiving combination drug therapy
- Total hypertensive patients
- Diabetic hypertensives
- Non-diabetic hypertensive patients with renal disease
- Patients with isolated systolic hypertension
- Hypertensives of African descent
- Use of single-pill combination therapy
- Resistant hypertension
- CHAPTER 7 FIRST- TO SECOND-LINE THERAPY
- First-line therapy
- Breakdown of antihypertensive first-line therapy by drug class
- ACE inhibitors
- Beta blockers
- Angiotensin II receptor blockers
- Calcium channel blockers
- Diuretics
- Second-line therapy
- Breakdown of antihypertensive second-line therapy by drug class
- ACE inhibitors: first versus second line
- Beta blockers
- Angiotensin II receptor blockers
- Calcium channel blockers
- Diuretics
- Breakdown of antihypertensive third-line therapy by drug class
- Changes in antihypertensive therapy
- Continuation and discontinuation of therapy
- Type of change in antihypertensive therapy
- Reasons for changes in antihypertensive therapy
- CHAPTER 8 INDIVIDUAL PRODUCT ASSESSMENT
- ACE inhibitors
- Breakdown of ACE inhibitor use
- Overall hypertensive population
- Subpopulation differences
- Branded versus generic ACE inhibitors
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
- Plain ACE inhibitor versus ACE inhibitor combinations
- Angiotensin II receptor blockers
- Breakdown of ARB use
- Overall hypertensive population
- Sub-population differences
- Plain ARB versus ARB diuretic single-pill combinations
- Key factors influencing ARB use in the future
- Beta blockers
- Breakdown of beta blocker use
- Overall hypertensive population
- Branded versus generic beta blockers
- Calcium channel blockers
- Breakdown of CCB use
- Overall hypertensive population
- Branded versus generic CCBs
- Diuretics
- Breakdown of diuretics inhibitor use
- Overall hypertensive population
- Branded versus generic diuretics
- CHAPTER 9 FUTURE DEVELOPMENTS
- Pipeline products
- Olmesartan-HCTZ single-pill combination: Benicar HCT
- Atorvastatin-amlodipine single-pill combination: Caduet
- Enalapril-lercanidipine single-pill combination: Zanipress
- Eplerenone: Inspra
- S-amlodipine
- Aliskiren (SPP-100)
- Prescription drivers of the antihypertensive market
- Efficacy and side-effect profile
- Quality of life improvement
- Use in niche populations
- Number of additional indications upon launch
- Marketing and pricing
- Single-pill combinations: with diuretic, cross-risk factor and
multi-modal drugs
- APPENDIX A BIBLIOGRAPHY
- References
- Hypertension management guidelines
- JNC 7
- ESH/ESC
- WHO/ISH
- BHS-IV
- APPENDIX B PRIMARY RESEARCH
- Physician research methodology
- Physician sample breakdown
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
- Questionnaire
- Diagnosis
- Treatment
- ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
- Diuretics
- Calcium channel blockers
- Beta blockers
- Treatment outcomes
- Future developments
- Disclaimer
- List of Tables
- Table 1: Prevalence of hypertension in the US (000s), 2005-15
- Table 2: Prevalence of hypertension in Japan (000s), 2005-15
- Table 3: Prevalence of hypertension in France (000s), 2005-15
- Table 4: Prevalence of hypertension in Germany (000s), 2005-15
- Table 5: Prevalence of hypertension in Italy (000s), 2005-15
- Table 6: Prevalence of hypertension in Spain (000s), 2005-15
- Table 7: Prevalence of hypertension in the UK (000s), 2005-15
- Table 8: Prevalence of hypertension in the seven major markets (000s),
2005-15
- Table 9: The statistical base of physician survey data relating to
patients of African descent per country, 2005
- Table 10: Proportion of hypertensives patients among consulting
population, 2005
- Table 11: Breakdown of hypertensive populations by disease severity in
the seven major markets, 2005
- Table 12: Estimated proportion of hypertensive patients with comorbid
conditions and risk factors in the seven major markets, 2005
- Table 13: Evolution of treatment guidelines with respect to target
blood pressure and therapy options: reducing the risk of nephropathy in
patients with diabetes or kidney disease
- Table 14: Distribution of physicians' SBP goals for diabetic
hypertensives with and without proteinuria across the seven major markets,
2005
- Table 15: Proportion of hypertensive patients receiving
antihypertensive drug therapy, 2005
- Table 16: Drug classes prescribed at any line of antihypertensive
therapy, 2005
- Table 17: Prescription of ACE inhibitors by patient type, 2005
- Table 18: Prescription of ARBs by patient type, 2005
- Table 19: Prescription of beta blockers by patient type, 2005
- Table 20: Physician opinion: CCBs are highly effective at lowering
blood pressure and are, therefore, beneficial as early lines of therapy,
2005
- Table 21: Prescription of CCBs by patient type, 2005
- Table 22: Prescription of diuretics by patient type, 2005
- Table 23: Proportion of hypertensive patients receiving monotherapy
and combination therapy in the seven major markets, 2005
- Table 24: Proportion of hypertensive patients remaining resistance
once all treatment options have been exhausted, 2005
- Table 25: Proportion of hypertensive patients receiving each class of
antihypertensive at first line in the seven major markets, 2005
- Table 26: Proportion of hypertensive patients receiving each class of
anti-hypertensive at second line in the seven major markets, 2005
- Table 27: Breakdown of ACE inhibitor prescribing in the overall
hypertensive population in the seven major markets, 2005
- Table 28: Breakdown of ACE inhibitor prescribing in hypertensive
patients with ISH in the seven major markets, 2005
- Table 29: Breakdown of ACE inhibitor prescribing in hypertensive
patients of African descent in the seven major markets, 2005
- Table 30: Drivers and resistors for genericization in the Italian
pharmaceutical market
- Table 31: Summary of current generic substitution policies in the EU5
- Table 32: BP goals defined in the new GMS contract
- Table 33: Prescription of plain ACE inhibitor vs. ACE
inhibitor-diuretic single-pill combination, 2005
- Table 34: Breakdown of ARB prescribing in the hypertensive population
in the seven major markets, 2005
- Table 35: Current indications for ARBs in addition to hypertension
- Table 36: Prescription of plain ARB vs. ARB-diuretic single-pill
combination, 2005
- Table 37: Proportion of physicians estimating their prescribing of
ARBs will increase or decrease over the next three years in the seven
major markets, 2005
- Table 38: Physicians' ratings of the importance of clinical or
regulatory influences on their ARB prescribing, 2005
- Table 39: Physician rating: key drivers and resistors of ARB
prescribing, 2005
- Table 40: Physician rating: ARBs should only be reserved for patients
that are unable to tolerate ACE inhibitors, 2005
- Table 41: Breakdown of beta blocker prescribing in the hypertensive
population in the seven major markets, 2005
- Table 42: Breakdown of CCB prescribing in the hypertensive population
in the seven major markets, 2005
- Table 43: Breakdown of diuretics prescribing in the hypertensive
population in the seven major markets, 2005
- Table 44: Physician awareness: Sankyo's olmesartan-HCTZ single-pill
combination (Benicar-HCT), 2005
- Table 45: Proportion of patients to whom interviewed physicians would
prescribe Benicar HCT in its first year on the market, 2005
- Table 46: Physician awareness of Pfizer's amlodipine-atorvastatin
single-pill combination (Caduet), 2005
- Table 47: Proportion of patients to whom interviewed physicians would
prescribe Caduet in its first year on the market, 2005
- Table 48: Physician awareness of Recordati's enalapril-lercanidipine
single-pill combination (Zanipress), 2005
- Table 49: Proportion of patients to whom interviewed physicians would
prescribe Zanipress in its first year on the market, 2005
- Table 50: Physician awareness of Pfizer's Inspra, 2005
- Table 51: Proportion of patients to whom interviewed physicians would
prescribe Inspra in its first year on the market as an antihypertensive,
2005
- Table 52: Physician awareness of Sepracor's S-amlodipine, 2005
- Table 53: Proportion of patients to whom interviewed physicians would
prescribe S-amlodipine in its first year on the market, 2005
- Table 54: Physician awareness of Novartis's aliskiren, 2005
- Table 55: Proportion of patients to whom interviewed physicians would
prescribe aliskiren in its first year on the market, 2005
- Table 56: Proportion of physicians estimating the impact of factors on
the uptake of new antihypertensives in the seven major markets, 2005
- Table 57: US physician sample breakdown, 2005
- Table 58: Japan physician sample breakdown, 2005
- Table 59: France physician sample breakdown, 2005
- Table 60: Germany physician sample breakdown, 2005
- Table 61: Italy physician sample breakdown, 2005
- Table 62: Spain physician sample breakdown, 2005
- Table 63: UK physician sample breakdown, 2005
- List of Figures
- Figure 1: Breakdown of the overall hypertensive population in the US
by diagnosis, subpopulations, disease severity and prevalence of
comorbidities, 2005
- Figure 2: Breakdown of the drug treated hypertensive population and
sub-populations by combination therapy and drug classes prescribed in the
US, 2005
- Figure 3: Breakdown of drug classes prescribed at first- and
second-line for the drug-treated hypertensive population and
sub-populations in the US, 2005
- Figure 4: Segmentation of the overall drug-treated hypertensive
population by drug class and individual compounds prescribed in the US,
2005
- Figure 5: Breakdown of the overall hypertensive and sub-populations by
diagnosis, disease severity and drug treatment in Japan, 2005
- Figure 6: Breakdown of the drug-treated hypertensive population and
sub-populations by combination therapy and drug classes prescribed in
Japan, 2005
- Figure 7: Breakdown of drug classes prescribed at first- and
second-line for the drug-treated hypertensive population and
sub-populations in Japan, 2005
- Figure 8: Segmentation of the overall drug-treated hypertensive
population by drug class and individual compounds prescribed in Japan, 2005
- Figure 9: Breakdown of the overall hypertensive and sub-populations by
diagnosis, disease severity and drug treatment in France, 2005
- Figure 10: Breakdown of the drug-treated hypertensive population and
sub-populations by combination therapy and drug classes prescribed in
France, 2005
- Figure 11: Breakdown of drug classes prescribed at first- and
second-line for the drug-treated hypertensive population and
sub-populations in France, 2005
- Figure 12: Segmentation of the overall drug-treated hypertensive
population by drug class and individual compounds prescribed in France,
2005
- Figure 13: Breakdown of the overall hypertensive and sub-populations
by diagnosis, disease severity and drug treatment in Germany, 2005
- Figure 14: Breakdown of the drug-treated hypertensive population and
sub-populations by combination therapy and drug classes prescribed in
Germany, 2005
- Figure 15: Breakdown of drug classes prescribed at first- and
second-line for the drug-treated hypertensive population and
sub-populations in Germany, 2005
- Figure 16: Segmentation of the overall drug-treated hypertensive
population by drug class and individual compounds prescribed in Germany,
2005
- Figure 17: Breakdown of the overall hypertensive and sub-populations
by diagnosis, disease severity and drug treatment in Italy, 2005
- Figure 18: Breakdown of the drug-treated hypertensive population and
sub-populations by combination therapy and drug classes prescribed in
Italy, 2005
- Figure 19: Breakdown of drug classes prescribed at first- and
second-line for the drug-treated hypertensive population and
sub-populations in Italy, 2005
- Figure 20: Segmentation of the overall drug-treated hypertensive
population by drug class and individual compounds prescribed in Italy, 2005
- Figure 21: Breakdown of the overall hypertensive and sub-populations
by diagnosis, disease severity and drug treatment in Spain, 2005
- Figure 22: Breakdown of the drug-treated hypertensive population and
sub-populations by combination therapy and drug classes prescribed in
Spain, 2005
- Figure 23: Breakdown of drug classes prescribed at first- and
second-line for the drug-treated hypertensive population and
sub-populations in Spain, 2005
- Figure 24: Segmentation of the overall drug-treated hypertensive
population by drug class and individual compounds prescribed in Spain, 2005
- Figure 25: Breakdown of the overall hypertensive and sub-populations
by diagnosis, disease severity and drug treatment in the UK, 2005
- Figure 26: Breakdown of the drug-treated hypertensive population and
sub-populations by combination therapy and drug classes prescribed in the
UK, 2005
- Figure 27: Breakdown of drug classes prescribed at first- and
second-line for the drug-treated hypertensive population and
sub-populations in the UK, 2005
- Figure 28: Segmentation of the overall drug-treated hypertensive
population by drug class and individual compounds prescribed in the UK,
2005
- Figure 29: Prevalence of hypertension in the seven major markets
(000s), 2005-15
- Figure 30: Proportion of interviewed physicians with hypertensive
patients of African descent, 2005
- Figure 31: Proportion of hypertensives patients among consulting
population, 2005
- Figure 32: Proportion of diagnosed hypertensive population that is
diabetic, 2005
- Figure 33: Proportion of the diagnosed hypertensive population that
has non-diabetic renal disease, 2005
- Figure 34: Proportion of the diagnosed hypertensive population that
has ISH, 2005
- Figure 35: Breakdown of overall hypertensive population by disease
severity in the seven major markets, 2005
- Figure 36: Country-average distribution of physicians' SBP goals for
diabetic hypertensives with and without proteinuria, 2005
- Figure 37: Pharmacological strategies for the inhibition of the
renin-angiotensin system
- Figure 38: The majority of patients need at least a combination of two
antihypertensive drugs to reach target BP
- Figure 39: Proportion of overall hypertensive patients receiving
different layers of therapy to varying extent in the seven major markets,
2005
- Figure 40: Proportion of diagnosed and drug treated hypertensive
patients reaching target blood pressure in the seven major markets, 2005
- Figure 41: Proportion of diabetic hypertensive patients receiving
different layers of therapy to varying extent in the seven major markets,
2005
- Figure 42: Proportion of diagnosed and drug-treated diabetic
hypertensive patients reaching target blood pressure in the seven major
markets, 2005
- Figure 43: Proportion of non-diabetic hypertensive patients with renal
disease receiving different layers of therapy to varying extent in the
seven major markets, 2005
- Figure 44: Proportion of diagnosed and drug treated non-diabetic
hypertensive patients with renal disease who are reaching target blood
pressure in the seven major markets, 2005
- Figure 45: Proportion of hypertensive patients with ISH receiving
different layers of therapy to varying extent in the seven major markets,
2005
- Figure 46: Proportion of diagnosed and drug treated hypertensive
patients with ISH who are reaching target blood pressure in the seven
major markets, 2005
- Figure 47: Proportion of hypertensive patients of African descent
receiving different layers of therapy to varying extent in the seven major
markets, 2005
- Figure 48: Proportion of diagnosed and drug-treated hypertensive
patients of African descent who are reaching target blood pressure in the
seven major markets, 2005
- Figure 49: Proportion of hypertensive patients receiving single-pill
combinations, 2005
- Figure 50: Use of diuretics-based single-pill combinations versus
diuretics-free single-pill combinations, 2005
- Figure 51: First line therapy: relative popularity of antihypertensive
drug classes used in the overall hypertensive population in the seven
major markets, 2005
- Figure 52: Proportion of hypertensive patients progressing to
second-line therapy in the seven major markets, 2005
- Figure 53: Second-line therapy: relative popularity of
antihypertensive drug classes used in the overall hypertensive population
in the seven major markets, 2005
- Figure 54: Proportion of overall hypertensive patients receiving ACE
inhibitors at first and second line in the seven major markets, 2005
- Figure 55: Proportion of overall hypertensive patients receiving beta
blockers at first- and second-line in the seven major markets, 2005
- Figure 56: Proportion of overall hypertensive patients receiving ARBs
at first and second line in the seven major markets, 2005
- Figure 57: Proportion of overall hypertensive patients receiving CCBs
at first and second line in the seven major markets, 2005
- Figure 58: Proportion of overall hypertensive patients receiving
diuretics at first and second line in the seven major markets, 2005
- Figure 59: Proportion of hypertensive patients progressing to
third-line therapy and beyond, 2005
- Figure 60: Proportion of patients discontinuing therapy in the course
of one year versus proportion of patients continuing therapy in the course
of one year, 2005
- Figure 61: Proportion of patients newly diagnosed with hypertension in
the course of one year, 2005
- Figure 62: Proportion of overall hypertensive patients undergoing
various changes in antihypertensive therapy in the seven major markets,
2005
- Figure 63: Reason for change in antihypertensive therapy in the seven
major markets, 2005
- Figure 64: Breakdown of ACE inhibitor prescribing in the overall
hypertensive population in the seven major markets, 2005
- Figure 65: Breakdown of ACE inhibitor use by branded and generic
compounds in the hypertensive population in the seven major markets, 2005
- Figure 66: Breakdown of ARB prescribing in the hypertensive population
in the seven major markets, 2005
- Figure 67: Proportion of physicians intending to change their
prescription of ARBs, 2005
- Figure 68: Breakdown of beta blocker prescribing in the hypertensive
population in the seven major markets, 2005
- Figure 69: Breakdown of beta blocker use by branded and generic
compounds in the hypertensive population in the seven major markets, 2005
- Figure 70: Breakdown of CCB prescribing in the hypertensive population
in the seven major markets, 2005
- Figure 71: Breakdown of calcium channel blocker use by branded and
generic compounds in the hypertensive population in the seven major
markets, 2005
- Figure 72: Breakdown of diuretics prescribing in the hypertensive
population in the seven major markets, 2005
- Figure 73: Breakdown of diuretics use by branded and generic compounds
in the hypertensive population in the seven major markets, 2005
- Figure 74: Physician awareness: Sankyo's olmesartan-HCTZ single-pill
combination (Benicar-HCT), 2005
- Figure 75: Physician awareness of Pfizer's amlodipine-atorvastatin
single pill combination (Caduet), 2005
- Figure 76: Physician awareness of Recordati's enalapril-lercanidipine
single-pill combination (Zanipress), 2005
- Figure 77: Physician awareness of Pfizer's Inspra, 2005
- Figure 78: Physician awareness of Sepracor's S-amlodipine, 2005
- Figure 79: Physician awareness of Novartis's aliskiren, 2005
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