Research Letter: Unmet Need for Hypertension Treatment in India: Evidence from Hypertension Drugs Market Data

Pathni, Anupam Khungar; Sahoo, Swagata Kumar; Moran, Andrew E.; Cohn, Jennifer; Bhatia, Sanchit; Maheshwari, Nilesh; Sharma, Bhawna

doi:10.5334/gh.973

Cited by 5 publications

(6 citation statements)

References 8 publications

(8 reference statements)

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“…65 Another study reported that around 70% of the estimated proportion of adults with hypertension did not receive antihypertensive drugs in 2018. 66…”

Section: Discussionmentioning

confidence: 99%

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Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

Koya

Pilakkadavath

Wilson³

et al. 2022

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Background: Hypertension is a significant contributor to mortality in India. This systematic review and meta-analysis aimed to understand the overall hypertension control rate in India, differences across sex and regions, and changes over time. Methods: Community-based, non-interventional studies published between 2001 and 2020 were searched in PubMed, Embase, and Web of Science. Modified New Castle-Ottawa scales was used to assess the risk of bias. We conducted a random-effects meta-analysis to provide summary estimates by including 29 studies that had a minimum sample size of 100 each. We also conducted subgroup analysis and meta-regression to explore changes in control rates over years and to explain the heterogeneity. Results: The systematic review included 170,631 hypertensive patients. The overall control rate was 33.2% (95% CI-27.9,38.6) with substantial heterogeneity, I2=99.1 % (95% CI-98.9,99.2; p <0.001). Subgroup analysis showed that hypertension control rates did not improve over the years (35.8% in 2011-2020 versus 29.6% in 2001-2010, p=0.23) and did not vary between males and females (34.2% for females and 28.2% for males, p=0.23). Control rates were significantly higher in the south region compared to other regions. Meta-regression model with sex, region, study period, and an interaction term for region and period of the study explained 76.5% of heterogeneity. Very few studies analyzed relevant factors that are associated with adequate control. Conclusion: Hypertension is adequately controlled only among one-third of patients in India. India needs more studies at community levels to understand the health system and socioeconomic factors that determine uncontrolled hypertension in India. PROSPERO registration: CRD42021267973

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“…65 Another study reported that around 70% of the estimated proportion of adults with hypertension did not receive antihypertensive drugs in 2018. 66…”

Section: Discussionmentioning

confidence: 99%

“…65 Another study reported that around 70% of the estimated proportion of adults with hypertension did not receive antihypertensive drugs in 2018. 66 Third, very few studies reported lifestyle and risk factors associated with poor control rates. Among them, Tripathy et.…”

Section: Discussionmentioning

confidence: 99%

Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

Koya

Pilakkadavath

Wilson³

et al. 2022

Preprint

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“…Whilst the IHCI is expanding in public sector facilities across the country, it is estimated that more than 70% of outpatient visits in India occur in the private health care sector [ 7 ]. There is a significant unmet need for hypertension treatment in the country [ 8 ], a gap that will only be filled by engaging the private sector in the campaign to achieve the country’s NCD goals. The Mumbai Hypertension Project was implemented by PATH and was designed to deliver the WHO HEARTS-IHCI hypertension management package in private sector primary care clinics situated in the urban slums of Mumbai, the principal city of Maharashtra state.…”

Section: Introductionmentioning

confidence: 99%

Delivering hypertension care in private-sector clinics of urban slum areas of India: the Mumbai Hypertension Project

et al. 2022

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In India, the private sector provides 70% of the total outpatient medical care. This study describes the Mumbai Hypertension Project, which aimed to deliver a standard hypertension management package in private sector clinics situated in urban slums. The project was conducted in two wards (one “lean” and one “intensive”) with 82 private providers in each. All hypertensive patients received free drug vouchers, baseline serum creatinine, adherence support, self-management counseling and follow-up calls. In the intensive-ward, project supported hub agents facilitated uptake of services. A total of 13,184 hypertensive patients were registered from January 2019 to February 2020. Baseline blood pressure (BP) control rates were higher in the intensive-ward (30%) compared with the lean-ward (13%). During the 14-month project period, 6752 (51%) patients followed-up, with participants in the intensive-ward more likely to follow-up (aOR: 2.31; p < 0.001). By project end, the 3–6-month cohort control rate changed little from baseline—29% for intensive ward and 14% for lean ward. Among those who followed up, proportion with controlled BP increased 13 percentage points in the intensive ward and 16 percentage points in the lean ward; median time to BP control was 97 days in the intensive-ward and 153 days in lean-ward (p < 0.001). Despite multiple quality-improvement interventions in Mumbai private sector clinics, loss to follow-up remained high, and BP control rates only improved in patients who followed up; but did not improve overall. Only with new systems to organize and incentivize patient follow-up will the Indian private sector contribute to achieving national hypertension control goals.

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“…Though the private antihypertensive drugs market seems massive, another study based on the same dataset showed that there is a significant unmet need for hypertension treatment with only 21.5% of the estimated hypertensive adults in the country receiving drug treatment from the private market [ 2 ].…”

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confidence: 99%

“…Amlodipine, atenolol, losartan, and enalapril were the commonly procured antihypertensive drugs in the public sector, but their volume of procurement is not available in the public domain. Though the private antihypertensive drugs market seems massive, another study based on the same dataset showed that there is a significant unmet need for hypertension treatment with only 21.5% of the estimated hypertensive adults in the country receiving drug treatment from the private market [2].…”

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confidence: 99%

Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016–2018

et al. 2021

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Background: India has a high burden of hypertension. While the private sector provides 70% of out-patient care in the country, a significant proportion of patients seeking care from the public sector buy drugs from private markets. This study aimed to describe India’s private sector antihypertensive drugs market at the national and state levels over 2016–2018. Methods: Antihypertensive drugs sales in India from 2016–2018 were analysed using a large nationally representative dataset for the private pharmaceuticals market. In addition, data for five states (Punjab, Madhya Pradesh, Kerala, Telangana, and Maharashtra) that were the foci of a large hypertension control program were studied. Results: The Indian hypertension drug market grew at a rate of 6.9% from 2016 to 2018 with a total of 21,066 million pills sales in 2018. Single-pill combinations (SPCs) contributed to 39.1% of total sale volumes. The market comprised of 182 different antihypertensive drugs including 134 SPCs. Total volume of sales covered a maximum of 26% of treatment need for the estimated population with hypertension. Two-drug SPCs had the highest market share (36%), followed by calcium channel blockers (18%), beta-blockers (16%) and angiotensin receptor blockers (14%). Among SPCs, amlodipine+atenolol had highest sales (9.8%). Twenty-five drugs, a mix of single drugs and SPCs, accounted for 80% of total sales. There were large state-to-state variations in sales per capita, preferred therapeutic classes and drugs. Conclusions: Despite the large antihypertensive drugs market, there exists a high unmet need for treatment in India. Inter-state differences in product sales indicate variable treatment practices, underscoring the need for private sector engagement to improve hypertension care practices aligned with national and international guidelines. SPCs contributed to a large share of the private market and inclusion of select antihypertensive SPCs in the national list of essential medications should be considered for the public health system.

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Research Letter: Unmet Need for Hypertension Treatment in India: Evidence from Hypertension Drugs Market Data

Cited by 5 publications

References 8 publications

Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

Population-level hypertension control rate in India: A systematic review and meta-analysis of community based non-interventional studies, 2001-2020

Delivering hypertension care in private-sector clinics of urban slum areas of India: the Mumbai Hypertension Project

Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016–2018

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