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Systemic hypertension

Systemic hypertension Disease Coverage
Report reference: DMKC12591 Published on: 27/06/2016 About Datamonitor Healthcare
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Systemic hypertension Disease Coverage
Executive Summary Market Overview and Trends Market Definition and Methodology Atacand (candesartan) Benicar (olmesartan) Diovan (valsartan) Edarbi (azilsartan) Micardis (telmisartan) Tekturna (aliskiren) Primary Research Methodology TREATMENT: SYSTEMIC HYPERTENSION
Executive Summary Primary Research Methodology Disease Definition and Diagnosis Patient Segmentation Country Treatment Trees Branded Treatments of Interest Prescribing Trends EPIDEMIOLOGY: SYSTEMIC HYPERTENSION IN THE US, JAPAN, AND 5EU
Executive Summary Disease Background Sources and Methodology Epidemiologist Insight Strengths and Limitations MARKETED DRUGS: SYSTEMIC HYPERTENSION
Executive Summary Angiotensin II Receptor Blockers Calcium Channel Blockers Other Drug Classes Product profile: Benicar Product profile: Diovan Product profile: Edarbi Product profile: Micardis Product profile: Tekturna Informa UK Ltd. This document is a licensed product and is not to be reproduced or redistributed

Systemic hypertension Disease Coverage
Executive Summary Informa UK Ltd. This document is a licensed product and is not to be reproduced or redistributed

Systemic hypertension Disease Coverage Treatment: Systemic

Across the seven surveyed markets, Datamonitor Healthcare's survey indicated an averagepharmacological treatment rate of 70% for Stage I hypertension as opposed to 96% in more severehypertension. The remaining diagnosed population is likely to have been prescribed therapeuticlifestyle management, which is the preferred first-line non-pharmacological measure in themanagement of hypertension. The JNC 8 and NICE guidelines for hypertension treatment recommendlifestyle changes as an important first step in achieving the target blood pressure in all patients withless severe Stage I hypertension or prehypertension (James et al., 2014; Mancia et al., 2013).
Figure 19: Percentage of pharmacologically treated hypertension patients across the US, Japan, and five major EU
markets, by country and stage
Source: Datamonitor Healthcare's proprietary hypertension survey, September 2015 STAGE I HYPERTENSIVE PATIENTS ARE MOST COMMONLY TREATED USING FIRST-LINE

Across the US, Japan, and five major EU markets (France, Germany, Italy, Spain, and the UK), 61–69%of Stage I hypertensive patients are on first-line therapy measures, with 22–27% on second line and9–12% on third line or later. Germany shows the highest proportion of patients receiving first-linetreatment, followed by the UK, but the variance across the seven surveyed markets remains small.
There are several opportunities to access significant patient populations by marketing bothmonotherapy and combination antihypertensives at multiple points along the treatment pathway(Datamonitor Healthcare's proprietary hypertension survey, September 2015).
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Systemic hypertension Disease Coverage Treatment: Systemic

Figure 25: Top three drug regimens for the second-line treatment of Stage II hypertension across the US, Japan, and five
major EU markets, by country
Source: Datamonitor Healthcare's proprietary hypertension survey, September 2015 FDCS ARE MORE COMMON IN THE THIRD-LINE TREATMENT OF STAGE II AND MORE SEVERE

FDCs are most commonly prescribed in the third-line treatment of Stage II and severe hypertension.
This observation is in line with the JNC 8 and European Society of Hypertension guidelines forhypertension treatment, which recommend using multi-drug combinations to achieve the target bloodpressure in severe forms of hypertension. These recommendations are based on the ability of FDCs toimprove treatment adherence in hypertensive patients, along with improved treatment outcomes(James et al., 2014; Gupta et al., 2010). Multi-drug combinations have been shown to produce greaterblood pressure reduction with significantly fewer side effects when compared to the monotherapyalone. Utilization of FDCs also helps to reduce the total number of tablets patients requiring two ormore drugs need to take, which is seen as advantageous by the prescribing physicians. The JNC 8guidelines state that more than two-thirds of hypertension patients require two or more agents toachieve the target blood pressure (James et al., 2014; Mancia et al., 2013).
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Systemic hypertension Disease Coverage Epidemiology: Systemic
Hypertension in the US, Japan, and 5EU

This is likely to be driven by population aging, which will increase the number of peoplesusceptible to developing hypertension.
The US is estimated to see the greatest increase in the number of prevalent cases over theforecast period (32.2%), followed by Spain (24.8%).
Meanwhile, Japan is expected to see the smallest increase in the number of prevalent cases ofhypertension (8.0%).
Figure 34: Absolute growth of prevalent cases of hypertension in the US, Japan, and five major EU markets, 2014–34
Source: Datamonitor Healthcare; Giampaoli et al., 2001; Perez-Fernandez et al., 2007;Ministry of Health, Labour and Welfare, 2011; Godet-Mardirossian et al., 2012; Centers forDisease Control and Prevention, 2013; Neuhauser et al., 2013; Health and Social CareInformation Centre, 2014 AGE- AND GENDER-SPECIFIC DISTRIBUTION OF HYPERTENSIVE CASES IS LARGELY SHAPED BY

In 2014, Datamonitor Healthcare estimates that the single largest proportion of prevalentcases of hypertension in the US, Japan, and five major EU markets was in those aged 60–69years (24.8% of total cases).
While most countries showed the highest number of cases in those aged 60–69 years,Germany showed a peak in the number of prevalent cases in those aged 70–79 years, and inSpain the highest number of cases was in those aged 50–59 years.
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Systemic hypertension Disease Coverage Marketed Drugs: Systemic

Figure 39: Datamonitor Healthcare's drug assessment summary of Benicar in hypertension
Source: Datamonitor Healthcare Benicar's high efficacy has led to strong commercial growth, despite its late market entry Despite being a late addition to the ARB drug class, the Benicar franchise has experienced significantcommercial growth due to the specific therapeutic advantages the drug offers. Combined global salesof Benicar and Benicar HCT grew from $422m in 2004 to $2,060m in 2014 (Datamonitor Healthcare,Company Analysis, Financial Analysis, December 2015). Sales of all products within the franchisereached $2,458m in 2014, representing 32% of Daiichi Sankyo's total revenue (Daiichi Sankyo ValueReport, 2015).
Benicar gained uptake in the hypertension market by demonstrating strong efficacy, tolerability, andconvenience. Head-to-head trials and meta-analyses comparing Benicar with older ARBs revealed thedrug's superior efficacy at reducing BP in patients with essential hypertension (Stumpe, 2004; Heranet al., 2008). Like other ARBs, Benicar has placebo-like tolerability across all doses and is administeredonce daily. This has supported the drug's use over a number of older drug classes which are not aswell tolerated and less convenient (Smith, 2008; Scrip Intelligence, 2003b).
Benicar has increased its share of the hypertension market despite initially entering a crowdedindication and drug class. A variety of antihypertensive drug classes were available prior to Benicar'slaunch, including a number of other ARBs such as Cozaar (losartan; Merck & Co), Diovan (valsartan;Novartis), Atacand (candesartan; AstraZeneca), and Avapro (irbesartan; Sanofi) (BioMedTracker,Copyright 2016, reprinted with permission). These drugs were already well established and widelyused, but Benicar was still able to establish itself as a major player in this market.
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