High blood pressure is an important risk factor for developing cardiovascular disease and premature death. Medication can reduce those risks so it makes sense that if someone is prescribed an angiotensin receptor blocker like Losartan continue to take it.

Yet people don't. A new cohort from Sweden using over 341,000 participants found that fewer than half were on their medication up to three years later. It can't be cost, their health care is overwhelmingly subsidized. It may be side effects.

The issue in America may not be either. If you have elevated blood pressure and begin taking the medication, unless you come in once per year for a battery of tests the doctor will refuse to renew your prescription. Doctors are not 'selling tests' as some conspiracy theories choose to believe, they
are practicing defensive medicine.(1)



We can complain about people not taking medication and blame socioeconomics but the reality is that people are tasked with doing things by physicians they know make no sense and are not helping them. Doctors know it too. Yet they signed up for it in droves.

Medical culture that will not renew your blood pressure medication unless you comply with useless tests masked as 'prevention' delays people with real medical issues from using the time you are wasting going to the doctor. It increases costs for everyone except the 50,000,000 people that the Biden administration said should have subsidized health care.(2)

Why do doctors do it? Part of it is practical. America has refused to create any kind of tort reform. Worse, the political party that says there should be Medicare For All rolls out new things for lawyers to sue about each year.(3) A doctor goes to medical school graduates from a 'teach to the protocol' environment. Then other physicians, administrators, and lawyers tell them what they must do to check off boxes when the inevitable lawsuit happens.

And it will happen. Data show 74 percent of obstetricians/gynecologists will face malpractice claims by age 45. Do OB/GYNs hate women? Are they incompetent? Of course not, government has baked physicians being treated like criminals into the process. And doctors have helped. The American Medical Association has outsized control over medical care guidelines and they like it and want to keep it. One political party trades votes for control. That is subtly shifting the political makeup of physicians.(4) In 2000, 60% of doctors were Republican, now only 20% are. Republicans became awful human beings, right? If you want to believe that, sure, but it cannot explain the skew any more than it can explain why 60% of Yale departments don't have even one Republican faculty member. Instead are being driven out before tenure, and with doctors those who are allowed to succeed support the 'teach to the protocol' environment, they like the political maneuvering of the AMA, and they voted for the ACA in large numbers.

Doctors who just want to do good medicine and will even start their own hospital with one like-minded doctors are forbidden by law. The Affordable Care Act that the AMA endorsed. They are not even allowed to create their own health insurance plan unless they get permission from existing health insurers, again than to the ACA. What doctor who says the system is wrong and intends to show a better way is going to get permission from Kaiser or Blue Shield or anyone else they are criticizing?

There are other reasons people may stop taking medication, like side effects, and the Swedish study found that the highest continued uptake over their seven-year window was ARBs, so it might make sense to start with one of those over beta-blockers like Metoprolol or diuretics like Hydrochlorothiazide.

But that may require the AMA to create policy that doctors must obey rather than letting doctors make the best decisions for patients and blaming health insurers when they can't.

NOTES:

(1) If you don't get mandatory meaningless tests they won't renew your blood pressure medication. But if you agree to blood work tests and your on-network doctor sends it to an out-of-network lab, a giant chunk of the $12,000 bill could be passed along to you. 

(2) The Affordable Care Act was deemed necessary because 700,000 people with pre-existing conditions could not get health insurance - but had incomes too high for public assistance. It would force greedy insurance companies to take them. That it became 50,000,000 and keeping them all on Obamacare caused a government shut down is why government is rarely here to help you.

(3) The 2004 Democratic Vice-Presidential nominee, Senator John Kerry, made his fortune suing doctors over the C-sections that are mandated when there is trouble. He convinced juries time and again they were unnecessary when doctors were trying to prevent the malpractice suits they got anyway. Now, even neurosurgeons, 80 percent of them, engage in defensive medicine knowing it increases costs and helps no one.

(4) This happens in all organizations that choose an ideological direction regardless of what their mandate is. After Vatican II was created to "liberalize" the Catholic church for the modern world, anyone who was conservative didn't make it through Seminary. Belief that the church could rehabilitate anyone is why so many sexual predators were shuffled from place to place when they would have been excommunicated and then thrown into jail until the 1960s.