The global direct medical costs of treating and managing hypertension are estimated at $370 billion yearly, according to Journal of Clinical Hypertension. Nigeria, with a population of over 180 million and a high prevalence of hypertension, contributes to the cost of managing this health challenge. However, while this has imposed a huge financial burden on hypertensive patients, the local market for hypertension drugs has literarily become a theatre of war for drug manufacturers and other care providers struggling for market dominance. DANIEL ESSIET reports.
That hypertension is a major threat to the well-being of people in sub-Saharan Africa (SSA) is not in doubt. Hypertension, otherwise known as high blood pressure, is a chronic medical condition in which the blood pressure in the arteries is elevated, with the World Health Organisation (WHO) estimating that the prevalence of hypertension is highest in the African region.
The WHO said, for instance, that about 46 per cent of adults in Africa aged 25 and older are hypertensive. The Pan-African Society of Cardiology (PASCAR) also lent its voice to the disturbing menace of the health challenge, identifying hypertension as the highest area of priority for action to reduce heart disease and stroke on the African continent.
Sadly, the prevalence of hypertension in Nigeria, according to experts, is high. For instance, a report published by Research Gate said there are about 20.8 million cases of hypertension in Nigeria among people aged at least 20. The report also projected an increase to 39.1 million cases of hypertension among people aged at least 20 years by 2030, if nothing is done to reverse the trend.
According to the report, which was accessed by The Nation, Nigeria’s rapidly aging and urbanising population is enjoying higher standards of living, which are often accompanied by obesity and, as a result, cardiovascular disease. Consequently, there is increasing rate of hypertension across the country, requiring urgent measures to stem the tide.
Indeed, experts say that the consumption of junk foods, lack of proper, healthy and balanced diet and lack of proper sleep, due to irregular work shifts, are major drivers for prevalence of the disease in Nigeria and by extension, the thriving anti-hypertensive drugs market.
However, by far, the most common treatment of hypertension is through special drugs. The remarkable success of a few recent launches has demonstrated the true potential of patented products
Some organisations and their international partners have stepped up the development of a variety of tools to reduce the high incidence of hypertension; some herbal providers are also deploying medicinal plants in the treatment and management of the problem.
The burgeoning industry, according to experts, needs lower-cost alternatives for desperately needed medications, and production should be on the rise. Of late, there has been rise in use of combination therapies for the treatment of hypertension.
Experts say that the use of combinations of drugs (Combination Therapy) allows for action on several different hypertensive mechanisms. However, as in so many other sectors, the rise of digital technology is reshaping the market.
Companies are using digital technology to simplify processes, enhance quality of care and prevention in the community, and empower patients.
Unsurprisingly, many hypertension drug manufacturers, therapists and caregivers have lined up to take advantage of the increasing number of hypertension patients in Nigeria to push their drugs and others solutions into the market. With so many hypertensive patients, the country’s anti-hypertensive drug market is booming.
The drug merchants, who are mostly private sector players, are encouraged by Nigeria’s large, rapidly growing market for hypertension, which includes research, discovery, testing, medical devices, and manufacturing of medicines and therapeutics that cure hypertension and improve patient’s health.
The Nation learnt that from local and multinational pharmaceutical companies to herbal providers, the competition for the provision of bespoke solutions for the treatment and management of hypertension in Nigeria has gained increased momentum. Companies manufacturing hypertension drugs are consolidating. Some of them are said to be partnering and manufacturing their own drugs in response to shortages and high prices.
The government is also encouraging local companies to develop drug production facilities. Some of the top players in the market include Eli Lilly and Company, Pfizer Inc. Bayer, Novartis, Merck & Co. Inc, Sanofi, Johnson & Johnson and Merck.
The key drugs in demand are systemic and pulmonary hypertension drugs. The major anti-hypertensive drugs, such as metoprolol, bisoprolol, perindopril and benazepril have a stable market share. While local companies are gaining traction, international brands are said to be still leading the pack. Nonetheless, the competition is fierce.
The market is growing at a very rapid pace. And with rise in technological innovation, analysts expect the market to remain innovation-led, with frequent acquisitions and strategic alliances adopted as the key strategies by the players to increase their industry presence.
The players are doing everything possible to protect their markets, using multi-pronged strategies such as dropping prices and offering patient assistance programmes. Continued pricing pressure is said to have led several of the major drug companies to re-evaluate their businesses.
For instance, global pharmaceutical company Eli Lilly appears poised to become the market leader. With a 142-year-long record in researching, creating, and marketing high-quality medicines, the company has established itself in the Nigerian hypertension business.
The other big player in the market is Pfizer. It has a great strength on domestic sales with prescription drugs indicated for anti-hypertension, anti-hyperlipidemia and anti-diabetics. The company has invested in drug development and the discovery of new medicines.
Bayer is also poised to give other hypertension drug manufacturers a run for their investments. An established and respected name in the pharmaceutical industry, Bayer engages in the research and development and production of active pharmaceutical products and intermediates, such as antivirals, antibiotics, antihistamines and anti-diabetics.
Its pharmaceutical’s researchers and scientists use state-of-the-art laboratories and equipment to develop new drugs to against hypertension.
Sanofi is another major contender. The company has reinforced its sustained commitment to healthcare through the provision of affordable medicines that are tailored to the needs of patients with the introduction of APROVASC, a fixed-dose combination treatment for the management of hypertension.
Sanofi, at the launch of the product, in Lagos, said the introduction of new APROVASC range, and the continual support of establishing clinics for the better management of the disease, was in direct response to the healthcare needs of patients with hypertension in Nigeria.
Also, to better support the patients in the management of the disease, Sanofi continues with its access to healthcare ambition in the opening of diabetes and hypertension clinics in partnership with health authorities. The first clinic was inaugurated at the Lagos State University Teaching Hospital (LASUTH) on January 29, 2015.
The General Manager, Sanofi Nigeria-Ghana, Abderrahmane Chakibi, said through leveraging APROVASC availability in Nigeria, Sanofi will continue to contribute to making the lives of Nigerian hypertensive patients healthier.
The company has built a global network for production, sales and Research & Development (R&D) not only in Nigeria, but also in main bases across the world and has provided globally competitive products.
Sanofi is also said to have actively penetrated into the overseas market and has expanded the pipelines for developing new drugs with active investment in R&D.
A thriving market for therapies
The use of therapies to treat hypertension has continued. The embrace of alternative medicine underscores how deep the use of therapies is in the treatment of hypertension. Apart from drugs and orthodox medical care, companies are now selling herbal remedies to treat hypertension.
The understanding is that anti-hypertensive medications work well for some people, but not for others, and the side effects can be unpleasant. However, those promoting alternative therapies are careful to say that they can supplement — but can’t replace — conventional treatments.
In place of medications, there are now herbal products. Products built from a combination of traditional herbs, such as lavender, fennel, and chamomile, now lower blood pressure. There are people that have switched their current hypertension treatments for herbal remedies.
Enter ketogenic diet
The ketogenic diet food market has gained a lot of popularity all over the world and is expected to reach $12.35 billion in 2024.
A ketogenic diet is a low or zero carbohydrate diet that has become the number one choice for treating different health issues and in reducing weight.
Diabetes and hypertension have become the most noticeable diseases in Nigeria in recent years. The ketogenic diet has gained a lot of attention in the past years for being the most effective strategy to lose weight.
A ketogenic diet is a low-carbohydrate, fat-rich eating plan, which is trending in the market due to its popularity for treating medical conditions and aiding in weight-loss. It is an effective treatment for hypertension. Lots of Nigerians are following the ketogenic diet trend.
Investment opportunities
Pharma companies are looking for new ways to boost hypertension drug discovery potential, reduce time to market and reduce costs along the whole value chain.
But for the depreciation of the naira, analysts see high drug prices as capable of helping to drive investment. The other issue is that Nigeria is also a market with a relatively predictable regulatory environment.
Nigeria has indeed, taken steps to reform its regulatory process to be more friendly towards foreign drug developers, with a particular focus on streamlining the approval process for products that have been licensed outside the country in developed markets such as the US and the EU.
International multi consultancy, Mckinsey, said Nigeria offers attractive opportunities for companies with realistic expectations and the ability to improve patients’ access to medicines.
It said the Nigerian pharma market could rise by as much as nine per cent a year to reach $3.6 billion by 2026 .The company said Nigeria could contribute between $1.9 billion and $2.2 billion to pharma sales growth, 55 per cent of it from prescription drugs.
Though the sector faces its fair share of challenges, health care provision may be about to turn a corner, with some major initiatives proposed or in the early rollout phase that could dramatically reshape the regulatory regime and re-designate roles and responsibilities for more effective outcomes.
One of these is the move to reduce the sale of counterfeit and sub-standard medicine in the local market. The National Agency for Food, Drug Administration and Control (NAFDAC) is implementing drug distribution guidelines that will prevent leakages and a parallel black market from functioning by introducing a more tightly coordinated and monitored distribution chain.
Pharmaceuticals manufacturers and importers are only permitted to sell drugs directly to Mega Drug Distribution Centres (MDDCs); State Drug Distribution Centres (SDDCs) and the national health programme.
From there, MDDCs can only sell to wholesalers, while SDDCs can re-distribute to public health facilities, and in some instances, the national health programme, as well as wholesalers.
Wholesalers, for their part, are only permitted to sell to community pharmacies, public health care facilities and private health institutions.
On the consumer-facing side, only pharmacies and public and private health care facilities that are registered with the Pharmaceutical Council of Nigeria can retail directly to the public.
In order to be registered as a participating pharmacy, one must have on board a superintendent pharmacist with at least five years of post-qualification retail experience.
To open a registered MDDC, a pharmacist with over 10 years of wholesale experience is needed to manage the operation.
To analysts, the guideline should reduce the challenges around counterfeiting by tracking and tracing product movement. It also opens up opportunities for new private businesses to participate in the distribution chain.
Then, there is the issue of changing eating habits and an increase in sedentary lifestyles among an expanding middle class that has contributed to a rise in the prevalence of hypertension and diabetes.
With rising levels of disposable income among some segments of society, there is greater demand for private coverage. Accordingly, the private sector has a significant role to play in ensuring reliable and affordable hypertension health care reaches all segments of society.
Experts speak
While the scramble for Nigeria’s hypertension drugs market is gaining momentum, medical experts have tasked the Federal and State governments to provide blood pressure measuring kits in work places and other locations to tackle the rising incidences of sudden death among Nigerians.
They gave the advice at the first annual lecture of the School of Health and Health Technology of the Federal University of Technology, Akure (FUTA) in Ondo State.
A consultant cardiologist, Obafemi Awolowo University Teaching Hospital, Prof. Oluwadare Ogunlade, who spoke on the theme: “Demystifying Hypertension: The Silent Killer”, urged government at all levels to provide blood pressure measuring kits in schools, work places and other locations to afford citizens the opportunity to freely measure blood pressure to prevent debilitating ailment and death.
Explaining further, the medical expert said hypertension is a silent killer “because in many cases it presents without symptoms until it is about to destroy its victims.”
He said though blood pressure is important for the working of the body, when continuously raised it can damage vital organs such as the kidneys, heart, the brain and other internal organs which end up manifesting on the outer body parts in form of stroke and other deadly diseases.
Ogunlade emphasised the need for regular check of blood pressure which he noted could be done with the use of appropriate kits at home and in the offices and not only in hospitals.
The cardiologist said a number of factors including the depressed economy, insecurity, insatiable desire and stress could be responsible for the increase in hypertension cases.
He advised Nigerians to be conscious of risk factors such as sweet things, alcohol, salt, obesity and hereditary causes to put the silent killer which he described as manageable in check.
FUTA’s Vice-Chancellor, Prof Joseph Fuwape, represented by the Dean, School of Earth and Mineral Sciences and Chair, Committee of Deans, Prof Pius Enikanselu, recalled that surveys have shown that more than 80 per cent of deaths in developing countries are caused by non-communicable diseases and half of those deaths involve people in their productive years.
This, according to him, has taken its toll on the development of the economy. He noted that FUTA, as a pacesetter has taken initiative and gotten patents in research projects for the management of Type-2 Diabetes Mellitus and High Blood Pressure recently as part of activities to rebuild the nation’s healthcare system.
He stated that the introduction and production of its Moringa, ginger and garlic breads was aimed at preventing some of such diseases as examples.
The Dean of the school, Prof Ayotunde Adeagbo, said the purpose of the lectures was to enlighten the public about the effective management of hypertension and other non-communicable diseases and chart a way forward for the reformation and improvement of the country’s health sector.