Since the early 1980’s, introductions of new antihypertensives have involved two major general mechanistic approaches: 1) agents affecting the renin-angiotensin system (involving three specific pharmacologic classes, and 2) agents inhibiting calcium channels (click on drugs for Hypertension). The number of approved NME’s belonging to these four pharmacologic classes and the number of years over which they were approved, are as follows:
- Angiotensin Converting Enzyme Inhibitors (ACEI): 10 NME’s; over 15 years & 1 month; 1981-1996
- Angiotensin II Receptor Blockers (ARB’s): 8 NME’s; over 15 years & 10 months; 1995-2011
- Renin Inhibitors: 1 NME; 2007, and
- Calcium Channel Blockers: 9 NME’s; over 13 years & 1 month; 1981-1995
During this general period of time, there have also been numerous approvals of Beta Blockers, as follows:
- Beta Adrenergic Blockers: 14 NME’s; over 40 years & 1 month; 1967-2007
In addition to these modern antihypertensives, there are numerous older antihypertensives, principally diuretics, centrally-acting drugs, and directly-acting vasodilators. Of note is that there are also numerous new combination drugs involving many of the above referred to antihypertensives and diuretics, but these are not included in this assessment, nor are any new formulations of previously approved drugs (see pages 4-5 in Methodology for Progression of Modern Therapeutics (2013) available under Reports on this website).
What is particularly noteworthy about this therapeutic class is: 1) the great number of NME approvals in the 1980’s and 1990’s, and 2) after 2000, there have only been four NME approvals, one beta blocker, two angiotensin II blockers, and one renin inhibitor. In fact, one can speculate that the high total number of approved NME’s, the significant number of drugs per each of the four key pharmacologic classes, and the low number of approved NME’s in the past 15 years do suggest the possibility of a mature therapeutic class. Such a speculation leads one to wonder how many other mature therapeutic or pharmacologic classes there might be.
Refer to page 7 of Progression Of Modern Therapeutics (2013) available under Reports on this website; this Report also includes the methodology used.