Hypertension and Diabetic Kidney Disease - Prevalence, current treatment and future options
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the cardiovascular pharmaceutical analysis team - page 2
- EXECUTIVE SUMMARY - page 5
- Introduction - page 5
- Scope and coverage of the Brief - page 5
- Methodology - page 5
- Key findings about the the topic - page 6
- EPIDEMIOLOGY - page 7
- Definition - page 7
- Etiology of diabetic nephropathy - page 9
- The role of hypertension in diabetic nephropathy - page 9
- Prevalence of hypertensive patients with diabetes - page 10
- Prevalence of hypertensive patients with diabetes - page 11
- Prevalence of nephropathy in type 2 diabetics - page 13
- Progression of diabetic nephropathy in type 2 patients. - page 15
- The growing burden of ESRD on healthcare systems - page 17
- Key factors influencing the ESRD market - page 19
- The increasing prevalence of ESRD - page 19
- ESRD occurrence is increasing in an aging population - page 21
- Increasing causal risk factors - diabetes and hypertension - page 22
- TREATMENT OF DIABETIC NEPHROPATHY - page 25
- Glucose control in diabetic nephropathy - page 25
- Importance of blood pressure control - page 25
- Pharmacological strategy: the role of the renin-angiotensin system - page 30
- The key components of the renin-angiotensin system - page 30
- The status of the renin-angiotensin system in diabetics - page 34
- Benefits of ACE inhibition - page 38
- Mechanism of action of ACE inhibitors - page 38
- Data supporting the renoprotective benefits of ACE inhibitors. - page 39
- The MICRO-HOPE study (2000): the benefits of ramipril - page 40
- The AASK study (2001): ramipril vs. metoprolol - page 41
- BENEDICT (2004): trandolapril - page 42
- DETAIL (2004): enalapril is not more efficacious than telmisartan - page 42
- Benefits of angiotensin II receptor blockade - page 43
- Mechanism of action of angiotensin II receptor blockers - page 43
- Current status of angiotensin II receptor blocker use in patients with diabetic nephropathy - page 43
- Overview - page 43
- The issue of dose in ARB-based therapy - page 44
- Class effect assumption - page 47
- FUTURE TREATMENT OF DIABETIC NEPHROPATHY - page 51
- Potential of the ACE/ARB combination - page 51
- Marketing rationale for the ACE/ARB combination - page 51
- Renin inhibition: what are the therapeutic opportunities? - page 53
- New compounds should target the underlying disease - page 54
- New approaches for diabetic microvascular complications - page 55
- Inhibitors of aldose reductase (ARIs) - page 56
- Protein kinase C-beta (PKC) inhibitors - page 56
- Advanced glycation end product (AGE) inhibitors - page 56
- Endothelin A receptor antagonists (ERAs) - page 57
- Potential treatments for diabetic nephropathy - page 58
- ALT-711 - page 59
- ALT-946 - page 59
- AVE-7688 - page 60
- CR002 - page 60
- Darusentan - page 60
- FG-3019 - page 61
- KRX-101 - page 61
- Pratosartan - page 62
- PTR-3173 - page 63
- Pyridorin - page 63
- Ruboxistaurin (LY-333531) - page 63
- SPP-100 (aliskiren) - page 64
- SPP-301 - page 66
- Conclusion - page 66
- Potential of the ACE/ARB combination - page 51
- APPENDIX - page 67
- Bibliography - page 67
- Epidemiology - page 67
- Treatment and novel agents - page 67
- Disclaimer - page 71
- Bibliography - page 67
- List of Tables
- Table 1: Changes in kidney structure and function in diabetic nephropathy - page 8
- Table 2: Prevalence of diabetic hypertension (millions), 2002-15 - page 10
- Table 3: Diabetic hypertensive population by sub-population across the seven major markets (millions), 2002-15 - page 12
- Table 4: Estimated prevalence of type 2 diabetic nephropathy in the seven major markets - page 14
- Table 5: Number of type 2 patients affected by diabetic nephropathy and time of progression across the seven major markets (millions), 2003 - page 15
- Table 6: Renal transplantation, hemodialysis and peritoneal dialysis prevalence rates by country (PMP), 2002 - page 17
- Table 7: Hemodialysis population by country (in 000s), 2002-12 - page 18
- Table 8: The growth and distribution of the risk causal factors in ESRD in the seven major nations - page 23
- Table 9: The growth and distribution of the risk causal factors in ESRD in the seven major nations - page 24
- Table 10: Evolution of treatment guidelines with respect to target blood pressure and therapy options: reducing the risk of nephropathy in patients with diabetes or kidney disease - page 27
- Table 11: JNC7: compelling indications for individual drug classes - page 28
- Table 12: Pharmacokinetic profiles of commercially available ARBs - page 45
- Table 13: Current indications for ARBs in addition to hypertension - page 49
- Table 14: Dual RAS blockade in patients with diabetic nephropathy - page 52
- Table 15: Renin inhibition reduces plasma renin activity - page 54
- Table 16: Nephropathy pipeline, 2005 - page 58
- List of Figures
- Figure 1: Prevalence of diabetic hypertension, 2002-15 - page 11
- Figure 2: Diabetic hypertensive population by sub-population across the seven major markets, 2002-15 - page 13
- Figure 3: Estimated progression of diabetic nephropathy in type 2 diabetes across the seven major markets - page 16
- Figure 4: Increased risk of death and diabetic nephropathy - page 17
- Figure 5: Hemodialysis population by country, 2002-12 - page 18
- Figure 6: Increasing prevalence of ESRD in the developed world - page 20
- Figure 7: Hemodialysis is preferred over peritoneal dialysis in all markets - page 21
- Figure 8: Age distribution and growth of prevalent ESRD patients - page 22
- Figure 9: The increasing prevalence of diabetes and hypertension in the major seven nations - page 23
- Figure 10: Guideline-based treatment tree: use of ACE inhibitors and ARBs in nephropathy patients - page 29
- Figure 11: The renin angiotensin system - page 31
- Figure 12: Angiotensin II is a cardiovascular risk factor with direct tissue effects - page 32
- Figure 13: Prorenin/renin receptor mediates the direct tissue effects of renin and prorenin - page 33
- Figure 14: Pharmacological strategies for the inhibition of the renin-angiotensin system - page 35
- Figure 15: The AT2 receptor may have positive as well as negative effects on the vasculature and end organs - page 36
- Figure 16: Mechanism of action of ACE inhibitors - page 39
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