高血圧治療に対する現在と将来のトレンド

Abstract

Overview

Introduction

Hypertension 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 and is thus inaccessible to antihypertensive pharmacotherapy.

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

Report 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 opinion on current treatment paradigms

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