Common blood pressure drugs may raise bleeding risk in older people

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A new study published in JAMA has raised concerns about a possible danger for older adults with atrial fibrillation—a common type of irregular heartbeat.

The research suggests that some blood pressure medications may increase the risk of serious bleeding, which could change how doctors treat these patients.

Atrial fibrillation, also known as AFib, can cause blood clots and raise the risk of stroke. To help prevent these problems, patients are usually given medications that thin the blood and control the heart rate. But when several drugs are taken at the same time, they can interact in ways that may cause unwanted side effects.

Dr. Eli Zimmerman, one of the study’s authors and a professor of stroke and vascular neurology, explained that our genes affect how well our bodies process medications. This means that the same drug can work differently from person to person. In people with AFib, who often take many drugs, these differences can be very important.

The study looked at Medicare patients aged 65 and older. These individuals began treatment between 2012 and 2020 using common blood thinners like apixaban or rivaroxaban. At the same time, they were also taking medications to control heart rate—either diltiazem or metoprolol.

The results showed that patients who took diltiazem were 20% more likely to be hospitalized or die from bleeding than those taking metoprolol. This may be because diltiazem affects how the body processes blood thinners, making the blood too thin and increasing the chance of bleeding.

Interestingly, the study found no major differences in stroke or clotting problems between the two groups. That means both medications were similarly effective in preventing clots, but diltiazem came with a greater risk of bleeding.

This finding is especially important for older adults, who are already more sensitive to both AFib and the side effects of the drugs used to treat it. Choosing the right combination of medications is a big challenge in making sure treatment is both safe and effective.

Dr. Zimmerman and his team now want to understand why some patients react differently to these medications. One idea is to monitor how much of the drug is in a patient’s blood. This might help doctors adjust the dosage or select safer drugs based on how each person’s body responds.

This approach could lead to more personalized care. Instead of using a one-size-fits-all plan, doctors could choose medications based on what works best for each patient, reducing side effects and improving outcomes.

The study also reminds us that lifestyle habits affect blood pressure too. For example, drinking too much coffee can raise blood pressure, especially in people who already have hypertension. On the flip side, healthier habits like eating plant-based meals or limiting food intake to earlier hours of the day have been shown to help lower blood pressure.

Overall, this research shows that doctors need to carefully weigh the risks and benefits of medications used to treat atrial fibrillation. By paying attention to how drugs interact and how individuals respond, healthcare providers can make better decisions that lead to safer and more effective treatment.

If you care about heart health, please read studies that Manganese can help clear arterial plaques and treat heart disease and Aspirin use linked to heart failure.

For more about heart health, please read studies about the blood thinner drug that can prevent strokes in people with hidden heart issues and new guidelines on daily aspirin for heart attack and stroke prevention.

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