Vision Shopsters: Hypertension: Competing Treatments and Market Entry Considerations

Vision Shopsters: Hypertension: Competing Treatments and Market Entry Considerations

This report presents the findings of a global survey on current treatments and prescribing practices for Hypertension. These findings were made following the participation of more than 280 clinics worldwide, which provided detailed information of their treatment practices.

Today, approximately 1 billion people worldwide have high blood pressure, a figure expected to increase to 1.5 billion by 2025, affecting 1 in 3 adults over the age of 20 (Lancet. 2005;365:217-223). Hypertension is commonly seen in developing as well as developed countries and, where it remains untreated, presents a major risk factor for heart attack, stroke, kidney failure and other cardiovascular diseases.

In a field where therapies are often unsatisfactory, physicians seek to extent their understanding and use of available treatments to improve patient outcomes. Knowledge in these areas is also important to drug developers, who seek a better understanding of prescribing practices and treatment needs and limitations from the clinician's perspective, as part of their own efforts to develop more effective therapies. To meet interest in these areas, Biopharm Reports has conducted a global survey on current treatments and drug prescribing practices for Hypertension. This survey involved the participation of more than 280 clinical centres in 50 countries. In addition to drugs directly used to treat Hypertension (e.g. Diuretics, Calcium Channel Blockers), other drugs commonly prescribed to hypertensive patients (e.g. Statins), were also surveyed. See Clinical Survey, below.

Overview

A global study of treatments and drug prescribing practices for Hypertension

The participation of more than 280 physicians in 51 countries.

Leading participant countries were the USA, Italy, Greece, Argentina Canada, China and Spain

98% of study participants are practicing physicians and 71% are specialists in Hypertension treatment

Of the participating organisations, 32% were hospital specialist hypertension departments, 18% were hospital general departments, 18% were specialist hypertension practices, 6% were private hypertension clinics and 3% were general practices. Others participants were specialised in areas such as cardiology and nephrology.

The diagnosis of eight Hypertension sub-types

Single or multiple drugs used to treat hypertension

Treatments and prescribing practices for 9 different drugs classes used to treat Hypertension

Diuretics: prescribing practices covering 16 different drugs

Beta Blockers and Alpha Blockers: prescribing practices covering 23 different drugs

Adrenergic Receptor Agonists: prescribing practices covering 4 different drugs.

Calcium channel blockers: prescribing practices covering 14 different drugs.

ACE Inhibitors: prescribing practices covering 12 different drugs.

Angiotension II Receptor Antagonists: prescribing practices covering 7 different drugs.

Statins: prescribing practices covering 6 different drugs

Aldosterone antagonists: prescribing practices covering 2 different drugs.

Drug combinations: prescribing practices involving the combined use of 9 different drug classes in the treatment of hypertension.

Combined drug formulations: Prescribing practices based on the use of 20 different combined drug formulations in the treatment of hypertension

Issues and challenges in the treatment of Hypertension: clinician's perspective

Clinical Survey

Organisation. Hospital General Department, Hospital Specialist Hypertension Department, Specialist Hypertension Practice, Private Hypertension Clinic, General Practice or other (specified).

Physicians. Specialist physician in Hypertension treatment, General physician or other (specified).

Hypertension Diagnosis: Estimated percentage of patients with normal blood pressure or diagnosed with Prehypertension, Stage 1 Hypertension, Stage 2 Hypertension, Isolated Systolic Hypertension, Resistant Hypertension, Drug-induced Hypertension, Pregnancy-related Hypertension, Exercise-related Hypertension or other secondary Hypertension (specified).

Single or Multiple Drugs. Estimated percentage of patients prescribed a single drug, two or more different drug classes taken together (e.g. two different tablets), combined drug formulations (two or more different drugs in one formulation) or other (specified).

Drug Classes. Estimated percentage of patients who are prescribed Diuretics, Beta Blockers (adrenergic receptor antagonists), Alpha Blockers (adrenergic receptor antagonists), Adrenergic Receptor Agonists, Calcium Channel Blockers, ACE Inhibitors, Angiotensin II Receptor Antagonists, Statins, Aldosterone Antagonists, Centrally Acting Antihypertensives, Vasodilators or other (specified).

Diuretics. Estimated percentage of patients prescribed ethacrynic acid (Edecrin, loop diuretic), torsemide (Demadex, loop diuretic), furosemide (Lasix, loop diuretic), bumetanide (Bumex, loop diuretic), epitizide (epitizide, thiazide diuretic), bendroflumethiazide (Aprinox; Neo-NaClex, thiazide diuretic), metolazone (Mykrox, Zaroxolyn, thiazide-like diuretic), hydrochlorothiazide (Esidrix, HydroDIURIL, thiazide diuretic), indapamide (Lozol, thiazide-like diuretic), chlorthalidone (Hygroton, thiazide-like diuretic), chlorothiazide (Diuril, thiazide-like diuretic), amiloride (Midamor, Amilamont, potassium-sparing diuretic), spironolactone (Aldactone, potassium-sparing diuretic), triamterene (Dyrenium,potassium-sparing diuretic), triamterene/hydrochlorothiazide (HCTZ) (Maxzide, Dyazide, combined diuretic formulation), furosemide/spironolactone (e.g. Osyrol-Lasix) or other (specified).

Beta Blockers and Alpha Blockers. Estimated percentage of patients prescribed the following Beta Blockers or Alpha Blockers, for the treatment of Hypertension: atenolol (e.g. Tenormin, Tenormine, Prenormine, Atenol, beta blocker), metoprolol (e.g. Betaloc-SA, Lopresor, Lopresor SR, beta blocker), nadolol (e.g. Corgard, beta blocker), Nebivolol (Nebilet, beta blocker), oxprenolol (e.g. Slow-Trasicor; Trasicor, beta blocker), pindolol (e.g. Visken, Betapindol, Calvisken, Decreten, beta blocker), propranolol, (e.g. Inderal, Inderal LA, Beta-Prograne, beta blocker), carvedilol (Coreg, beta blocker), bisoprolol (e.g. Cardicor,Concor) timolol (e.g. Blocadren, beta blocker), ebivolol (e.g. Nebilet), acebutolol (e.g. Sectral, beta blocker), betaxolol (e.g. Kerlone, beta blocker), carteolol (e.g. Cartrol, beta blocker), penbutolol (e.g. Levatol, beta blocker), doxazosin (e.g. Cardura,Carduran, alpha blocker), phentolamine (e.g Regitine, alpha blocker), indoramin (e.g. Doralese, alpha blocker), phenoxybenzamine (e.g. Dibenzyline, alpha blocker), prazosin(e.g. Hypovase, alpha blocker), terazosin (e.g Hytrin, Hytrin BPH, alpha blocker), carvedilol (e.g. Coreg, mixed alpha and beta blocker), labetalol (e.g. Normodyne, Trandate, mixed alpha and beta blocker) or other (specified).

Adrenergic Receptor Agonist. Estimated percentage of patients prescribed the following adrenergic receptor agonists, for the treatment of Hypertension: Options: clonidine (e.g. Catapres, Catapres-TTS-1, Catapres-TTS-2, Duraclon), methyldopa (e.g. Aldomet, Apo-Methyldopa, Dopamet, Novomedopa), rilmenidine (e.g. Hyperium), guanfacine (e.g. Tenex), other. If other, please specify.

Calcium Channel Blockers. Estimated percentage of patients prescribed the following calcium channel blockers, for the treatment of ypertension: Options: nimodipine (e.g. Nimotop), diltiazem (e.g. Cardizem, Dilacor), amlodipine (e.g. Norvasc), felodipine (e.g. Plendil), isradipine (e.g. DynaCirc), verapamil (e.g. Calan, Isoptin, Verelan), manidipine (e.g. Iperten), nisoldipine (e.g. Sular), nicardipine (e.g. Cardene), nifedipine (e.g. Adalat, Procardia), lercanidipine (e.g. Zanidip) lacidipine (e.g. Lacipil,Motens), nitrendipine (e.g. Nitrepin), Clevidipine (e.g. Cleviprex) or other (specified).

ACE Inhibitors. Estimated percentage of patients prescribed ACE inhibitors, for the treatment of Hypertension: Options: captopril (e.g. Capoten), enalapril (e.g. Vasotec), quinapril (e.g. Accupril), benazepril (e.g. Lotensin), cilazapril (e.g. Vascace), ramipril (e.g. Altace), perindopril (e.g. Aceon) lisinopril (e.g. Prinivil, Zestril), fosinopril (e.g. Staril), trandolapril (e.g Gopten), imidapril (e.g. Tanatril), moexipril (e.g. Univasc) or others (specified).

Angiotension II Receptor Antagonists. Estimated percentage of patients prescribed the following angiotensin II receptor antagonists, for the treatment of Hypertension: losartan (e.g. Cozaar, Hyzaar), olmesartan (e.g. Benicar), candesartan (e.g. Atacand), telmisartan (e.g. Micardis), eprosartan (e.g. Teveten), irbesartan (e.g. Avapro), valsartan (e.g. Diovan) or others (specified).

Statins. Estimated percentage of patients prescribed statins, for the treatment of Hypertension: Options: atorvastatin (e.g.Lipitor), fluvastatin (e.g.Lescol), lovastatin (e.g.Mevacor), pravastatin (e.g.Pravachol), simvastatin (e.g. Zocor), rosuvastatin e.g.Crestor) or others (specified).

Aldosterone Antagonists. Estimated percentage of patients prescribed the following aldosterone antagonists, for the treatment of Hypertension: Options: eplerenone (e.g.Inspra), spironolactone (e.g. Aldactone, Verospiron) or others (specified)

Centrally Acting Antihypertensive Drugs. Estimated percentage of your patients who are prescribed the following centrally acting drugs, for the treatment of Hypertension: Options: clonidine (e.g.Catapres), guanfacine (e.g.Tenex), Guanabenz (e.g.Wytensin), methyldopa (e.g.Aldomet), rilmenidine (Hyperium), moxonidine (Physiotens) or others (specified).

Other drugs. Estimated percentage of patients prescribed the following centrally acting drugs, for the treatment of Hypertension: clonidine (e.g.Catapres), guanfacine (e.g.Tenex), Guanabenz (e.g.Wytensin), methyldopa (e.g.Aldomet), rilmenidine (Hyperium), moxonidine (Physiotens) or others (specified).

Drug Combinations. 1st, 2nd and 3rd most frequently used combinations of individual drugs classes used for the treatment of Hypertension (i.e where two or more different drugs (e.g. two different tablets) are prescribed for use by the patient at the same time). Drugs classes considered include Diuretics, Beta blockers, Alpha blockers, Adrenergic receptor agonists, Calcium channel blockers, ACE inhibitors, Angiotensin II receptor antagonists, Statins, Aldosterone antagonists or others (specified).

Combined Drug Formulations. Estimated percentage of patients prescribed co-formulated or combined drugs for the treatment of Hypertension including the options clonidine hydrochloride/chlorthalidone (e.g. Clorpres), captopril/ hydrochlorothiazide tablets (e.g. Capozide), spironolactone/hydrochlorothiazide (e.g. Aldactazide), triamterene/hydrochlorothiazide (e.g. Dyazide), valsartan/hydrochlorothiazide (e.g. Diovan HCT), amlodipine/atorvastatin (e.g. Caduet), telmisartan/hydrochlorothiazide (HCTZ) (e.g. Micardis HCT), irbersartan/hydrochlorothiazide (HCTZ) (e.g. Avalide,CoAprovel), trandolapril/verapamil (e.g Tarka), enalapril/hydrochlorothiazid (e.g. Vaseretic), amlodipine/valsartan (e.g. Exforge), olmesartan/amlodipine (e.g. Azor), aliskiren/hydrochlorothiazide (HCTZ))(e.g. Tekturna HCT), amlodipine/benazepril (e.g. Lotrel), Olmesartan Medoxomil / Hydrochlorothiazide (e.g. Benicar HCT), losartan/hydrochlorothiazide (e.g. Hyzaar), perindopril/amlodipine, delapril/manidipine, lercanidipine/enalapril, lisinopril/amlodipine or others (specified).

Challenges and Issues in the treatment of Hypertension: clinician's perspective

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