A recent study published in JAMA has found that certain blood pressure medications may raise the risk of serious bleeding in older adults with atrial fibrillation—a common type of irregular heartbeat. The findings are especially important for people aged 65 and older who take more than one type of heart medication.
Atrial fibrillation, often called AFib, makes the heart beat irregularly and increases the risk of blood clots and stroke. To reduce these risks, many people with AFib take two types of medications: blood thinners to prevent clots, and drugs to slow down the heart rate. However, when these drugs are taken together, they can sometimes cause unexpected side effects.
In this study, researchers looked at Medicare records of patients 65 and older who started using one of two common blood thinners—apixaban or rivaroxaban—between 2012 and 2020.
These patients also took either diltiazem or metoprolol to control their heart rate. The team wanted to see if there were differences in health outcomes depending on which combination of drugs was used.
They found that patients taking diltiazem were 20% more likely to be hospitalized or die from bleeding compared to those taking metoprolol. However, the two groups had similar risks of stroke and other heart-related complications, meaning that the main difference was in bleeding risk.
One possible reason for this is how the body breaks down medications. People process drugs differently, often because of genetic differences. Diltiazem may affect how the body clears blood thinners like apixaban and rivaroxaban, causing higher levels of these drugs in the blood. This can increase the chance of bleeding.
Dr. Eli Zimmerman, one of the study’s authors and a specialist in stroke and vascular neurology, said this research shows how important it is to understand how medications interact—and how they are processed in different people. He emphasized that using multiple medications at once, which is common in older adults, increases the risk of side effects.
The researchers say more studies are needed to understand why some people have more bleeding problems with certain drugs. One idea they’re exploring is whether checking blood drug levels more often could help doctors better manage the risks. This might lead to more personalized treatment plans based on how each person’s body responds to medicine.
For now, the message is clear: doctors and patients need to be careful when choosing medication combinations for atrial fibrillation, especially in older adults. It’s important to have regular checkups and open conversations with your doctor about side effects and any changes in how you feel.
This study is part of a growing effort to make heart care safer and more tailored to each patient. As we learn more about how medications work in the body, treatment can become both more effective and safer—helping people live longer, healthier lives with fewer complications.
If you care about blood pressure, please read studies about unhealthy habits that could increase high blood pressure risk, and people with severe high blood pressure should reduce coffee intake.
For more information about blood pressure, please see recent studies that early time-restricted eating could help improve blood pressure, and results showing plant-based foods could benefit people with high blood pressure.
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