 Treatment Algorithms --
May 2007
 In This Issue...
Introduction:
Despite the availability of an array of effective
hypertension medications, patients’ blood pressure is frequently not controlled
within target levels. Clinical studies have shown that current antihypertensive
agents are efficacious in lowering BP and ultimately reducing associated
morbidity and mortality. Hence, opinion leaders are treating patients
aggressively by adding more molecules that act via a variety of different
mechanisms to their patients’ regimens; patients are commonly treated with
three drugs or more simultaneously. Because hypertension is an asymptomatic
disease requiring chronic treatment, there are inherent compliance problems for
patients, which are made even worse by the need to treat the disease with
multiple agents. Hence, there is considerable need remaining in this market for
drugs that treat hypertension effectively and aid compliance, which is served
primarily through the gaining popularity of fixed-dose combinations.
Questions Answered in This Report:
- Lines of therapy: Thought leaders tell us that it
commonly takes two or more antihypertensive medications to control patients’
blood pressure. Do practicing physicians follow the recommendations of
experts? How many drugs on average do patients receive second and third
line?
- Pathway to key therapies: Experts recommend prescribing
angiotensin II receptor antagonists (AIIRAs) if angiotensin-converting enzyme
inhibitors (ACEIs) are causing patients to cough. How much of AIIRA use is
devoted to first-line treatment, and when they are prescribed later in therapy,
what drugs are they switched away from or added to? Do physicians add AIIRAs to
treatment with ACEIs?
- Physician behavior: Experts are reducing their
prescribing of traditional beta blockers (BBs) and are prescribing vasodilating
beta blockers, such as GlaxoSmithKline’s Coreg (carvedilol), instead as these
BBs cause less metabolic adverse effects. Are practicing physicians
following this trend? What perception do PCPs and cardiologists have of
traditional beta blockers?
- Forecast: Novartis will launch both Tekturna (aliskiren)
and Exforge (amlodipine/valsartan) in 2007. What perception do practicing
physicians have of these new products and in what lines of therapy will they be
prescribed?
Includes:
Primary research: Quantitative results from our
survey of 149 physicians (74 cardiologists and 75 PCPs):
- Physician opinion on how drug use differs by patient severity.
- Most influential drug attributes when physicians choose between
agents.
- Anticipated changes in the line of therapy in which physicians
use key agents.
Primary patient-level data: Quantitative findings
from our analysis of data covering 55 million lives from more than 80
geographically disperse U.S. HMOs:
- Quantified lines of therapy analysis showing exact share of
each agent in each line of therapy, including rate of progression between lines
and length of time patients are on each line.
- Progression flowcharts through one year of treatment for newly
diagnosed patients receiving each of the following first-line agents: Diuretics,
Inspra, Spironolactone, Coreg, other beta blockers, Altace, captopril,
enalapril, lisinopril, other ACEIs, Atacand, Avapro, Benicar, Cozaar, Diovan,
Micardis, Teveten, benazepril/hydrochlorothiazide,
captopril/hydrochlorothiazide, enalapril/hydrochlorothiazide,
lisinopril/hydrochlorothiazide, Benicar HCT, Diovan HCT, Hyzaar, diltiazem, nifedipine,
Norvasc, verapamil, other calcium-channel blockers (CCB), Caduet, Lotrel, and
Tarka.
- Flowcharts tracking the preceding therapy patterns for patients
taking each of the following key therapies: Altace, enalapril, lisinopril,
Avapro, Atacand, Cozaar, Diovan, Micardis, nifedipine, Norvasc, Lotrel, Tarka.
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