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Business News › Industry › Healthcare/Biotech › Healthcare › Beta Blockers – A discovery that transformed cardiac disease management!

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Beta Blockers – A discovery that transformed

cardiac disease management!
1
SECTIONS
Spotlight Beta Blockers
Wire Last Updated: – A2023,
Jun 13, discovery that
07:22:00 PMtransformed
IST cardiac disease management!
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Synopsis
The advent of selective beta-blockers has transformed cardiovascular medicine by
providing clinicians with a range of tailored treatment options. Read to know more

Cardiovascular diseases (CVDs), one of

Spotlight Wire

the world's leading causes of death,

claim as many as 17.9 million lives each
year globally. According to a study by
the Indian Council of Medical Research
and Registrar General of India, India
accounts for approximately 60% of the
global burden of heart disease.
Additionally, the study highlights a
high prevalence of hypertension in the country, with as much as 30% of the
population aYected. Notably, 62.5% of newly diagnosed hypertensive
individuals have high sympathetic overactivity. The study further found that
there is a signi]cant lack of awareness, treatment, and control of high blood
pressure among young adults with hypertension.

Amongst the armamentarium of drugs for the management of cardiac disease,

the advent of selective beta-blockers has transformed cardiovascular medicine
by providing clinicians with a range of tailored treatment options. These
medications have revolutionised the management of hypertension, angina,
and heart failure by speci]cally targeting beta-1 receptors while minimising
adverse eYects on other physiological systems.
Spotlight Wire

The journey of beta-blocker development began in the mid-20th century when

scientists delved into understanding the role of the sympathetic nervous
system in cardiovascular function. A signi]cant milestone in beta-blocker
development occurred in the 1950s when James W. Black and his colleagues
focused on receptor pharmacology, aiming to identify compounds that could
alone block the beta-adrenergic receptor subtype. In the early 1960s, Black and
his team developed a molecule called propranolol, which later paved the way
for more cardio (beta-1 receptors in the heart)-selective and convenient beta-
blockers like bisoprolol.
Spotlight Wire

Bisoprolol, for instance, has gained the trust of patients worldwide for over 3
decades. It is widely utilised as a reliable and well-established medication in
the management of various conditions. Its selectivity for beta-1 receptors
made it a favourable choice in patients with concomitant respiratory
conditions.

The most prominent question that arises in our mind is how beta-blockers
work. These medications exert their eYects by blocking the release of stress
hormones, such as adrenaline and noradrenaline, in speci]c areas of the body.
As a result, they slow down the heart rate and decrease the force with which
blood is pumped throughout the body. Additionally, beta blockers can inhibit
the production of a hormone called angiotensin II by the kidneys,
contributing to the signi]cant lowering of blood pressure.

Researchers and cardiologists have found strong evidence that taking a beta
blocker after a heart attack decreases the chances of early death by 44%.
Beta-blockers are also known to improve long-term outcomes in heart failure,
blood pressure control and coronary diseases. Beta-blockers have been
extensively used globally, and the cardio-selective ones are known to be well
tolerated in most patients, leading to high compliance among patients.
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Therefore, we, at Merck, on this day, pay our tributes to Sir James Whyte Black
for the novel discovery of Beta-blockers on his 99th birth anniversary. (14 June
1924 – 22 March 2010).

Here is what the doctors have to say:

Spotlight Wire

Dr Jamshed J Dalal, Mumbai, said, “Beta blockers are important drugs in the
management of the whole spectrum of cardiovascular disease. They are used
in the treatment of hypertension, heart failure, coronary artery disease,
cardiomyopathies and arrhythmias. Indians have a higher heart rate than
Westerners, and beta blockers help stabilise it. They not only relieve symptoms
but often improve survival. They are also used for tremors, migraine and
glaucoma. They have been extensively used in India for many decades and
helped millions of people. For this, we owe gratitude to Sir James Black, who
developed this molecule.”

Dr J C Mohan, Delhi, said, “Bisoprolol represents the best-in-class beta

blocker with strong evidence and least side eYects. Its ease of use, compliance,
and adherence are remarkable.”
Dr Arup Dasbiswas, Kolkata, said, “India is the world capital of
cardiovascular disease (CVD), and CVD is the leading cause of death. Beta-
blockers, particularly highly cardio-selective beta blockers like bisoprolol, are
very useful drugs, reducing the eYects of sympathetic hyperactivity. Beta-
blockers are a class of medications that block the eYects of adrenaline and
related stress hormones. They are commonly prescribed to treat high blood
pressure, fast heart rates, heart rhythm disorders, angina, and heart failure.
After a heart attack, they decrease mortality and further events. Bisoprolol has
more good eYects and less of side eYects.”

Dr Jayagopal P B, Palakkad, said, “One of the biggest breakthroughs in the

therapy of angina, hypertension, and cardiovascular disease, has been the
advent of beta-blockers in the market. Undoubtedly, beta-blocker therapy has
been a blessing for patients with angina. Following heart attacks, the eYicacy
is well established. This is one of the guideline-directed medical therapy for
reducing death and hospital admissions. Bisoprolol, introduced as the beta-
blocker of choice in smokers, is indeed a very eYective agent. Its long duration
of action and safety in patients with diabetes, dyslipidemia and kidney
disease makes it one of the most desirable agents. This is my preferred beta-
blocker in cardiac patients.”

Disclaimer: The views and opinions eDpressed in the story are

independent professional judgement of the eDperts and we do not take
any responsibility for the accuracy of their views. This should not be
considered as a substitute for medical advice. Please consult your treating
physician for more details. The above is non-editorial content and ET does
not guarantee, vouch or endorse any of the above content, nor is it
responsible for them in any manner whatsoever. Please take all steps
necessary to ascertain that any information and content provided is
correct, updated, and veriIed.

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HCG stake sale: A big acquisition deal likely

coming up for HCG as EQT, TPG and KKR eye
majority stake
By Arijit Barman & Viswanath Pilla, ET Bureau Last Updated: Feb 19, 2024, 12:17:00 PM IST
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Synopsis
A rising middle-class and an aging population have boosted demand for private medical
services across Asia, which in turn, is seeing massive consolidation and heightened deal
activity in the healthcare sector.

Agencies
Mumbai: Global buyout funds EQT
(formerly Baring PE Asia-EQT), TPG
Capital and KKR are among those
evaluating the acquisition of a
controlling stake held by CVC Capital
in Bengaluru-based specialty cancer
hospital chain Healthcare Global
Enterprises (HCG), sources told ET.
Representative Image

A rising middle-class and an aging population have boosted demand for

private medical services across Asia, which in turn, is seeing massive
consolidation and heightened deal activity in the healthcare sector.

Luxembourg-based CVC manages 188 billion of assets and is also owner of

the Gujarat Titans’ IPL franchise, international rugby union, Women’s Tennis
Association and top football properties such as Spain's La Liga or consumer
brands like Lipton Teas, Peruvian cash management company Hermes, among
others. It owns around 60.41% stake in HCG.

BS Ajai Kumar, an oncologist-turned-entrepreneur and founder of HCG, and

his family members own about 11% stake in the company.

The US PE fund bought a controlling stake in HCG in June 2020 for about Rs
1,049 crore by buying new shares and convertible warrants. It acquired more
shares later through a mandatory open oYer.
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FEB 19, 2024

As on February 18, CVC stake in HCG would be worth around Rs 3,236 crore.
The deal would involve an open oYer for an additional 26% of the company.
The current market value of the hospital chain is Rs 5,357.38 crore. A recent
report by brokerage ]rm JeYeries also highlighted that CVC’s investment in
the cancer hospital chain has increased 2.7 times in less than three years.

In the past one month, the HCG stock is up 10% as the sale gathers
momentum.

CVC Capital is working with two Wall Street advisors for the sale that has
been launched in recent weeks. The oYicial sale process was launched
recently.

Ajai Kumar told ET that he is not looking to sell his stake and exit.

“There is no intention to exit. I have founded and built HCG, and am

committed to the cause of serving cancer patients,” said Ajai Kumar, executive
chairman of HCG.

EQT declined to comment. CVC, TPG and KKR were not available for
comment.

Both these funds are involved in the biggest hospital deals involving private
equity (PE) investors in India. While KKR had one of its big pay days exiting
Max Healthcare in what was the largest block deal in the Indian stock
market history, TPG has backed several hospital chains but its largest bet has
been Manipal. Last year, TPG, an investor in Manipal since 2015, chose to fully
exit Ranjan Pai’s hospital chain by selling its stake to Temasek, but it also
decided to reinvest in Manipal via a new fund, albeit with a smaller holding.

Even EQT that has traditionally been overweight on tech and BPO deals has
been doubling down on healthcare. In 2022, EQT bought Hyderabad-
headquartered super specialty hospital AIG (Asian Institute of
Gastroenterology), pipping TPG. Last September, it acquired 60-65% of Indira
IVF for $650-700 million, the largest provider of fertility services in India and
also among the top ]ve globally in terms of annual in-vitro fertilisation (IVF)
cycles, for a billion-dollar valuation, in a headline-grabbing deal.

HCG has 1,926 operational beds, of which nearly three-fourths belong to

matured hospitals and the rest from the new ones. The company is spending
Rs 132 crore on capex on two hospitals — Ahmedabad (Rs 106 crore) and
White]eld, Bengaluru (Rs 25 crore).

Founded in 2005, HCG now operates 22 cancer hospitals and three

multispecialty hospitals across India. The network also includes one cancer
care centre in Kenya.

The debt-fuelled expansion and Covid-19 pandemic that disrupted cancer care
services have massively dented the company's ]nancial performance,
particularly in FY21.

Cancer care infrastructure, especially facilities to oYer radiation therapy, are

expensive.

The timely equity infusion by CVC and the appointment of Raj Gore as CEO in
February 2021, who prioritised operational eYiciency, cost optimisation and
rationalisation of bed capacities, have helped HCG to get back in the pink of
health.

Operating ProIt, Revenue

HCG revenues grew 13% year-on-year (YoY) in the nine months ended
December 31 to Rs 1,417.5 crore. It has an earnings before interest, tax,
depreciation and amortisation (ebitda) margin of 17.3% in the same period.

The company said it is striving to achieve 20% ebitda margin and revenue
growth above the market growth rate of 10-11%. The net debt stood at Rs 367
crore as on December 2023.

The consolidated revenue grew by 21% during FY23 on the back of increased
admissions and procedures performed. The momentum was sustained in
H1FY24, with the company reporting growth of 14.5% on Yo-Y basis.

While in absolute terms, the pro]t before depreciation, interest and tax
(PBDIT) of the company grew but PBDIT margins improved marginally from
17.06% in FY22 to 17.60% in FY23 as increasing share of low-margin medical
oncology and continuing losses in some of the new centres like south Mumbai
and Kolkata limited margin gains. Nevertheless, these new centres have been
witnessing increasing footfalls and are likely to turnaround in the near term.

HCGEL is ]rmly placed to tap the increasing demand for cancer treatment,
which would continue to drive the revenue growth, said CARE Ratings in a
recent credit note.

HCG has also been looking to acquire cancer hospitals. In FY24 alone, HCG
announced acquisitions of 120-bed Nagpur Cancer Hospital and Research
Institute and 100-bed SRJ CBCC Cancer Hospital in Indore, giving the
hospital chain a ]rm footing in central India and south India.

Analysts believe its dominant presence in cancer care treatment is driven by

strong brand equity and superior quality of service along with partnership
with other established medical professionals. The company also operates
seven IVF fertility centres under the brand ‘Milann’ through its wholly owned
subsidiary, BACC Healthcare Private Limited (BACC).

EQT may subsequently explore merging it with Indira if it emerges as the

successful bidder.

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