Pipeline Insight: Antihypertensives - Together We Stand, Divided We Fail

Overview

Introduction

Analysis of key late stage developmental therapies in the anti-hypertensives market.

• It is no longer possible to identify one particular class of drugs as the current gold-standard treatment in hypertension.
• While many physicians remain frustrated by the limited capability of individual antihypertensive agents to lower blood pressure to target levels, there is no superclass on the horizon with the ability to treat hypertension effectively using monotherapy. Instead, the solution will lie in physicians' acceptance of the need to use effective drug combinations earlier in treatment and the wider issue of patient education and involvement in therapy decisions.
• The need to address risk factors beyond hypertension, in particular raised lipids, has led to a demand for combination therapies that can treat more than one risk factor at a time. Antihypertensive combinations, both with and without a statin, are likely to be common in the future.
• BMS's vasopeptidase inhibitor Vanlev (omapatrilat) had demonstrated the greatest antihypertensive efficacy among novel compounds in recent years, giving rise to the development of several other potential members in this class. However, it appears that fear of litigation surrounding the potential for angioedema has restricted further progress of this class.
• Despite continued research into logical hypertension targets such as endothelin and vasopressin, the potential for any of these agents to be successful in the treatment of essential hypertension appears limited.
• The only agent likely to significantly challenge the unbridled growth of the ARBs during the forecast period will be Novartis's oral renin inhibitor, aliskiren. While renin inhibition has long been a logical therapeutic objective, formulation difficulties had kept it an elusive goal until now. Its intervention in the familiar renin angiotensin aldosterone system (RAAS) at a point earlier than both ACE inhibitors and ARBs may mean it will offer superior blockade of the RAAS than either class without the bradycardia-related side effects of ACE inhibitors.