MacroSnaps3 November 2026
No. 115Britain and America take the same cholesterol pill. But for blood pressure each country's favourite pill is one the other barely uses: ramipril is England's 5th most common prescription and America's 237th.
England, share of prescriptionsAmerica
Atorvastatin
5.8%
US 3.8%
Levothyroxine
2.7%
US 2.7%
Ramipril
2.8%
US 0.06%
Lisinopril
0.6%
US 2.2%
Bisoprolol
2.4%
US 0.06%
Metoprolol
0.02%
US 1.9%
Lansoprazole
2.9%
US 0.07%
Omeprazole
2.9%
US 1.6%
Each medicine's share of all prescriptions, England 2024/25 and America 2024. Ramipril and lisinopril both lower blood pressure, bisoprolol and metoprolol both steady the heart, lansoprazole and omeprazole both cut stomach acid.
Why this is happening
- The pairs do the same job. Ramipril and lisinopril both relax blood vessels to lower blood pressure; bisoprolol and metoprolol both slow the heart. Trials find little to choose between them.
- Habit and guidelines. Doctors prescribe what they were taught and what local guidance lists, so whichever pill a country settled on early tends to stay on top.
- The NHS steers GPs to a short list of cheap generics, so in England one pill can take almost all of a job.
The take
The illnesses are the same: both countries' top medicine is atorvastatin, for cholesterol, and both take the same thyroid pill. But which blood pressure or heart pill you get depends mostly on where you live. England's 3rd, 5th and 7th most common prescriptions are 208th, 237th and 228th in America.