Hypertension and Diabetic Kidney Disease - Prevalence, current treatment and future options

Table of Contents

• ABOUT DATAMONITOR HEALTHCARE
  • About the cardiovascular pharmaceutical analysis team
• EXECUTIVE SUMMARY
  • Introduction
  • Scope and coverage of the Brief
  • Methodology
  • Key findings about the the topic
• EPIDEMIOLOGY
  • Definition
  • Etiology of diabetic nephropathy
  • The role of hypertension in diabetic nephropathy
  • Prevalence of hypertensive patients with diabetes
  • Prevalence of hypertensive patients with diabetes
  • Prevalence of nephropathy in type 2 diabetics
  • Progression of diabetic nephropathy in type 2 patients.
  • The growing burden of ESRD on healthcare systems
  • Key factors influencing the ESRD market
    • The increasing prevalence of ESRD
    • ESRD occurrence is increasing in an aging population
    • Increasing causal risk factors - diabetes andhypertension
• TREATMENT OF DIABETIC NEPHROPATHY
  • Glucose control in diabetic nephropathy
  • Importance of blood pressure control
  • Pharmacological strategy: the role of therenin-angiotensin system
    • The key components of the renin-angiotensin system
    • The status of the renin-angiotensin system in diabetics
  • Benefits of ACE inhibition
    • Mechanism of action of ACE inhibitors
    • Data supporting the renoprotective benefits of ACEinhibitors.
      • The MICRO-HOPE study (2000): the benefits of ramipril
      • The AASK study (2001): ramipril vs. metoprolol
      • BENEDICT (2004): trandolapril
      • DETAIL (2004): enalapril is not more efficacious thantelmisartan
  • Benefits of angiotensin II receptor blockade
    • Mechanism of action of angiotensin II receptor blockers
    • Current status of angiotensin II receptor blocker use inpatients with diabetic nephropathy
      • Overview
      • The issue of dose in ARB-based therapy
    • Class effect assumption
• FUTURE TREATMENT OF DIABETIC NEPHROPATHY
  • Potential of the ACE/ARB combination
    • Marketing rationale for the ACE/ARB combination
  • Renin inhibition: what are the therapeuticopportunities?
  • New compounds should target the underlying disease
  • New approaches for diabetic microvascular complications
    • Inhibitors of aldose reductase (ARIs)
    • Protein kinase C-beta (PKC) inhibitors
    • Advanced glycation end product (AGE) inhibitors
    • Endothelin A receptor antagonists (ERAs)
  • Potential treatments for diabetic nephropathy
    • ALT-711
    • ALT-946
    • AVE-7688
    • CR002
    • Darusentan
    • FG-3019
    • KRX-101
    • Pratosartan
    • PTR-3173
    • Pyridorin
    • Ruboxistaurin (LY-333531)
    • SPP-100 (aliskiren)
    • SPP-301
  • Conclusion
• APPENDIX
  • Bibliography
    • Epidemiology
    • Treatment and novel agents
  • Disclaimer
• List of Tables
  • Table 1: Changes in kidney structure and function indiabetic nephropathy
  • Table 2: Prevalence of diabetic hypertension(millions), 2002-15
  • Table 3: Diabetic hypertensive population bysub-population across the seven major markets (millions), 2002-15
  • Table 4: Estimated prevalence of type 2 diabeticnephropathy in the seven major markets
  • Table 5: Number of type 2 patients affected bydiabetic nephropathy and time of progression across the seven majormarkets (millions), 2003
  • Table 6: Renal transplantation, hemodialysis andperitoneal dialysis prevalence rates by country (PMP), 2002
  • Table 7: Hemodialysis population by country (in 000s),2002-12
  • Table 8: The growth and distribution of the riskcausal factors in ESRD in the seven major nations
  • Table 9: The growth and distribution of the riskcausal factors in ESRD in the seven major nations
  • Table 10: Evolution of treatment guidelines withrespect to target blood pressure and therapy options: reducing the riskof nephropathy in patients with diabetes or kidney disease
  • Table 11: JNC7: compelling indications for individualdrug classes
  • Table 12: Pharmacokinetic profiles of commerciallyavailable ARBs
  • Table 13: Current indications for ARBs in addition tohypertension
  • Table 14: Dual RAS blockade in patients with diabeticnephropathy
  • Table 15: Renin inhibition reduces plasma reninactivity
  • Table 16: Nephropathy pipeline, 2005
• List of Figures
  • Figure 1: Prevalence of diabetic hypertension, 2002-15
  • Figure 2: Diabetic hypertensive population bysub-population across the seven major markets, 2002-15
  • Figure 3: Estimated progression of diabeticnephropathy in type 2 diabetes across the seven major markets
  • Figure 4: Increased risk of death and diabeticnephropathy
  • Figure 5: Hemodialysis population by country, 2002-12
  • Figure 6: Increasing prevalence of ESRD in thedeveloped world
  • Figure 7: Hemodialysis is preferred over peritonealdialysis in all markets
  • Figure 8: Age distribution and growth of prevalentESRD patients
  • Figure 9: The increasing prevalence of diabetes andhypertension in the major seven nations
  • Figure 10: Guideline-based treatment tree: use of ACEinhibitors and ARBs in nephropathy patients
  • Figure 11: The renin angiotensin system
  • Figure 12: Angiotensin II is a cardiovascular riskfactor with direct tissue effects
  • Figure 13: Prorenin/renin receptor mediates the directtissue effects of renin and prorenin
  • Figure 14: Pharmacological strategies for theinhibition of the renin-angiotensin system
  • Figure 15: The AT2 receptor may have positive as wellas negative effects on the vasculature and end organs
  • Figure 16: Mechanism of action of ACE inhibitors