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UK doctors slow to
utilize combination therapy for hypertension
UK doctors slow to utilize combination therapy for
hypertension
According to new Datamonitor research, the
majority of hypertension sufferers
are not fully controlled on a single
antihypertensive
therapy. With many patients requiring a combination of two or three drugs
from different classes to adequately lower their blood pressure, not enough
doctors are recognizing the importance of multiple drug administration.
UK doctors slow to utilize combination therapy for
hypertension
UK doctors slow to utilize combination
therapy for hypertension
(Published 24th December 2004)
According to new Datamonitor research, the majority of
hypertension
sufferers are not fully controlled on a single
antihypertensive
therapy. With many patients requiring a combination of two or three drugs
from different classes to adequately lower their blood pressure, not enough
doctors are recognizing the importance of multiple drug
administration.
Datamonitor estimates that over one in four people
globally suffer from hypertension, yet some doctors (especially those in the
UK) have yet to come to appreciate the importance of using multiple drugs to
control the condition in their patients.
Small difference, big
effect
Clinical trials on hypertension patients continue to show
that even small differences in blood pressure can have a significant effect on
mortality outcome. Doctors have been accused of being slow to appreciate this
fact, with too many patients still being inadequately treated with a single
drug in combination with lifestyle modifications such as reduced salt intake
and weight loss.
Now more physicians are starting to appreciate the
importance of treating hypertension all the way to target blood pressure, and
patients are increasingly taking drugs from more than one class.
It is
estimated that there are currently almost 17 million Britons with
hypertension (high
blood pressure), a chronic disease that if not treated, may lead to other
cardiovascular disorders like heart attacks and strokes. The prevalence of
hypertension will continue to increase due to the aging nature of the world's
population. However, the rising incidence of type II diabetes and the obesity
epidemic will continue to drive up treatment rates even within other age
groups.
UK trailing
The UK has also trailed the US, Japan
and other European nations in the use of fixed-dose combination treatments,
where more than one active ingredient is combined in a single pill or capsule.
Doctors in the UK have traditionally been very averse to using fixed-dose
combinations, generally due to the teaching in medical schools that fixed doses
prevent the ability of the physician to accurately adjust the doses of
individual components or detect problems caused by a single component of a
combination.
This attitude may be set to change in the near future
however, as teaching methods are brought more in line with those around the
world, which acknowledge the increased compliance and efficacy of combined
treatments. This change will make the UK a fast-growing market for combination
products over the next 10 years, as a newer generation of physicians educated
on the importance of blood pressure control but without the aversion to
fixed-dose combinations joins the prescribing ranks.
There is currently
no consensus gold-standard antihypertensive treatment, and no single drug has
displayed significantly superior overall efficacy compared to other classes.
Drugs from a number of different classes with distinct methods of action are
used in lowering blood pressure, including: angiotensin II receptor blockers
(ARB), angiotensin converting enzyme (ACE) inhibitors and calcium channel
blockers (CCB). These three largest antihypertensive drug classes now account
for over three quarters of the total market value. The fastest growing class of
antihypertensive drug is the ARBs, which have rapidly drawn level with the
second highest selling class of antihypertensive, the ACE inhibitors. However
both currently trail the CCB class.
Growing market
The
antihypertensive market was worth $30 billion in 2003 (an increase of $3.5
billion on the previous year) and as a result of the increasing market size and
the continuing switch from the use of older drugs to more costly newer
versions, the antihypertensives market is expected to increase in value by $6.5
billion over the next 10 years.
More patients are also being treated
along new guidelines, which focus on overall cardiovascular risk, and thus the
prescribing of a number of classes of drugs for each patient, which obviously
also increases sales.
Although the sales of antihypertensive treatments
continue to grow, the market is set for a period of consolidation as patent
expiries and the emergence of cheaper generic versions drive down costs of the
biggest selling branded drugs.
The US market accounts for 48% of the
global value and is the largest and most mature market, showing the lowest
market growth rate of 4.5% year on year during the period 2000-03, compared to
a global average of 7.5%.
Pfizer's
Norvasc, a CCB also known
as amlodipine, is the world's biggest selling antihypertensive and the fourth
highest value pharmaceutical in the world. It alone accounts for almost 15% of
the antihypertensive sales market, with over $4.3 billion in global sales in
2003. However Norvasc looks set to lose the market leading position it has held
for over five years as it suffers patent expiry throughout the main markets
over the coming years, culminating with the patent expiry in the US during
2007.
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