antihypertensive therapy-market review 2013

Download ANTIHYPERTENSIVE THERAPY-market review 2013

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Basics of hypertension and available treatment. Overview of mechanism of action, risks/benefits of various classes of drugs. Prevalent prescription trends and future market review.



2. Disease overview Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. 3. The Truth is It is only a marker of the bigger problem Hypertension is a multi-organ systemic disease What we record as B.P. The Problem is Hypertension is asymptomatic in 85% of cases 4. What three factors contribute to blood pressure? 5. Epidemiology 6. Hypertension: the worlds number 1 CV risk factor 7.6 million premature deaths worldwide 13.5% of global total deaths Causes more deaths than any other risk factor, including smoking or high cholesterol 7. Hypertension is the most powerful risk factor for cardiovascular morbidity and mortality Global burden of disease 16 million 78 million 43 million 23 million Global mortality 128 million 59 million 39 million 30 million All cardiovascular High BP High cholesterol Overweight and obesity Ezzati et al. PloS Med 2005;2:e133 8. Hypertension is a leading cause of death and disability in all regions Region Death Disability* East Asia & Pacific 13.6% 6.5% Europe & Central Asia 35.0% 19.6% Latin America & The Caribbean 13.0% 5.1% Middle East & North Africa 16.5% 6.1% South Asia 9.6% 4.3% Sub-Saharan Africa 4.0% 1.7% Low-/ middle-income economies 12.9% 5.6% High-income economies 17.6% 9.3% World 13.5% 6.0% Lawes et al. Lancet 2008;371:15138 9. BP is often not controlled, even when treated 0 10 20 30 40 50 60 70 80 Aware Treated Controlled USA Canada Italy Sweden Spain England Germany Wolf-Maier et al. Hypertension 2004;43:1017 * Threshold of SBP/DBP 140/90 mm Hg 10. Each 20/10 mm Hg BP increase doubles the risk of CV mortality 1-fold 2-fold 4-fold 8-fold 0 2 4 6 8 10 SBP/DBP, mm Hg * Individuals aged 4069 years (N = 1 million). Lewington S, et al. Lancet. 2002;360:19031913. 11. Hypertension adds to other CV risk factors Other risk factors SBP 120129 DBP 8084 SBP 130139 DBP 8589 SBP 140159 DBP 9099 SBP 160179 DBP 100109 SBP 180 DBP 110 None Average risk Average risk Low added risk Moderate added risk High added risk 12 Low added risk Low added risk Moderate added risk Moderate added risk Very high added risk 3, OD, MS or diabetes Moderate added risk High added risk High added risk High added risk Very high added risk CV or renal disease Very high added risk Very high added risk Very high added risk Very high added risk Very high added risk MS, metabolic syndrome; OD, subclinical organ damage ESHESC Guidelines. J Hypertens 2007;25:11051187 12. Treatment goals and algorithms 13. Treatment Goal The Truth is Keep B.P. < 140/90 mm Hg in each patient This may be revised to 120/80 may be ? 110/70 It is essential to keep the B.P at or below the goal But, It also matters how the goal B.P. is achieved ! Goal BP 14. Current BP targets according to guidelines JNC VII 2003 ESH-ESC 2007 WHO-ISH BHS IV 2006


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