INDIA Antihypertensive Drugs Market Factsheet

This factsheet gives an overview of the private sector antihypertensive drugs market in India over 2016-2018 and its trend by volume, value, per capita sales, preferred drug classes and molecules to support strengthening of the hypertension control program in the country.

Prevalence of hypertension Antihypertensive Sales per among 18+ population* market in 2018 capita in 2018 25.3% 21,066 24 million pills pills (sales volume) per adult (age 18+) Estimated number of 18+ adults with hypertension in 2018 87,357 96 million INR pills per adult 220 million (sales value) (age 18+) with hypertension

Antihypertensive drugs sales trend, 2016-2018

Sales volume (pills in millions) Sales value (INR in million)

CAGR: 6.9% CAGR: 8.4% 21,067 87,357 19,555 78,915 18,429 74,360

2016 2017 2018 2016 2017 2018

Total volume of sales by type of molecule and drug class, 2016-2018 Single molecule vs single-pill combination (SPC) Single molecule by type of drug class (pills in millions) (pills in millions)

3,852 CCB 3,518 3,226

3,444 BB 3,261 3,152

3,078 ARB 2,766 2,492 12,825

11,863 1,121 11,118 Diuretic 1,042 969 7,650 7,189 6,872 758 ACEI 764

591 787 439 503 305 2016 2017 2018 Others# 258 254 Single molecule 2 drug SPC 267 AB 255 3 or more drug SPC 238 2018 2017 2016

# Drug classes include formulations of Clonidine, Methyl dopa, Moxonidine, Dihydralazine and * Source: DLHS4/AHS Aliskerin as those do not fall under the classes defined for this analysis. CAGR - Compound annual growth rate CCB: calcium channel blockers, BB: beta blockers, ARB: angiotensin receptor blockers, ACEI: angiotensin converting enzyme inhibitors, AB: alpha blockers www.resolvetosavelives.org 1 Top 25 molecules in 2018: India Based on sales volumes (pills in millions) and their percentage contribution to total sales of antihypertensive drugs in India

Amlodipine 2405 11% Amlodipine + Atenolol 2060 10% Telmisartan 1833 9% Metoprolol Succinate 1348 6% Telmisartan + Hydrochlorothiazide 858 4% Amlodipine + Telmisartan 794 4% Atenolol 720 3% Losartan 717 3% Cilnidipine 648 3% Propranolol Hydrochloride 565 3% Losartan + Hydrochlorothiazide 456 2% Torsemide 443 2% Ramipril 436 2% Nifedipine 427 2% Olmesartan Medoxomil 382 2% Telmisartan + Chlorthalidone 364 2% Amlodipine + Metoprolol 345 2% Furosemide 312 1% Levamlodipine Besylate 294 1% Nebivolol Hydrochloride 292 1% Enalapril Maleate 267 1% Amlodipine + Hydrochlorothiazide + Telmisartan 261 1% Prazosin Hydrochloride 260 1% Spironolactone + Torsemide 258 1% Single molecule Bisoprolol Fumarate 255 1% Single-pill combination

Price to consumer of selected antihypertensive drugs in 2018 Maximum retail price (MRP) of selected antihypertensive drugs included in State hypertension treatment protocols (as single and combination products)

No. of brands Median price MRP range per Drug class Molecule Strength considered per tablet (INR) tablet (INR)

ACEI Enalapril 5 mg 10 3.36 2.10 - 3.52

Losartan 50 mg 10 4.6 2.16 - 6.6 ARB Telmisartan 40 mg 12 7.19 3.40 - 7.33

CCB Amlodipine 5 mg 10 2.8 0.68 - 2.86

Chlorthalidone 12.5 mg 7 5.79 2.00 - 6.86 Diuretic Hydrochlorothiazide 25 mg 7 1.77 1.53 - 1.85

CCB + ARB Amlodipine + Telmisartan 5 mg/40 mg 13 10.7 3.35 - 14.30

Chlorthalidone + Telmisartan 12.5 mg/40 mg 10 10.28 3.75 - 14.62 Diuretic + Hydrochlorothiazide + Telmisartan 12.5 mg/40 mg 12 9.08 3.53 - 15.48 ARB Hydrochlorothiazide + Losartan 12.5 mg/50 mg 7 6.38 3.00 - 11.95

CCB + Amlodipine + Chlorthalidone + Telmisartan 5 mg/12.5 mg/40 mg 3 10.49 9.80 - 11.71 Diuretic + Amlodipine + Hydrochlorothiazide + 5 mg/12.5 mg/40 mg 2 9.85 7.86 - 11.85 ARB Telmisartan The market sales data was collected by IQVIA, a private healthcare market research company, on behalf of Resolve to Save Lives, an initiative of Vital Strategies. Based on this data, the following studies have been published: 1. Prices of combination medicines and single-molecule antihypertensive medicines in India’s private health care sector. The Journal of Clinical Hypertension. 2020. https://doi.org/10.1111/jch.14143 2. Research Letter: Unmet Need for Hypertension Treatment in India: Evidence from Hypertension Drugs Market Data. Global Heart. 2021. https://doi.org/10.5334/gh.973