Stakeholder Insight: Hypertension - Multiple Layers of Therapy Cover all Eventualities

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