High blood pressure (hypertension) is a chronic condition often without symptoms that is linked to serious health issues such as heart disease and stroke, if not detected early and treated appropriately.

The most important drug classes for treatment of hypertension with generics competition are diuretics, calcium antagonists, beta blocker, ACE-inhibitors and AT-II-antagonists. Generics competition for these classes began in the early 1970s (diuretics) up to the more recent generics competition for AT-II-antagonists (Losartan) in 2010.

Generics will create a patient-related benefit if they contribute to an increased patient adherence to long-term therapy or compliance. In Italy, where patients have to make co-payments for brand-name drugs, a positive impact on adherence has been shown. Although in The Netherlands, where both generic and originator medicines are fully covered, adherence after substitution was still higher for patients substituted with a generic hypertensive drug (92.4%) compared with non-substituted patients (90.4%). One explanation for this could be that pharmacies usually educate patients about the reasons for generics substitution, possibly increasing awareness about the benefits of adherent drug use. Negative perceptions have, however, also been reported. Patients’ acceptance of generics substitution is influenced by age, educational levels, perceptions of disease, generic drug information, and depending on who informed them about the change.

When considering cost-effectiveness, Watanabe et al. (2014) estimated that the cost of hypertension control medications for non-diabetic patients to gain an additional quality-of-life year (QALY) versus non-treatment dropped by about 85% when substituting available generics for brand-name medications (from US$52,983 to US$7,753).

In conclusion, hypertension generics can increase patient adherence depending on co-payments and education, while also being cost-effective for governments and payers.

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