A new study published in JAMA has raised concerns about the safety of certain blood pressure medications for people with atrial fibrillation (AFib)—a common type of irregular heartbeat. The research suggests that some patients taking these medications may face a higher risk of serious bleeding, which could change how doctors manage their treatment.

Understanding Atrial Fibrillation and Its Treatment

AFib is a condition where the heart beats irregularly, increasing the risk of blood clots and strokes. To lower these risks, doctors often prescribe anticoagulants (blood thinners) to prevent clotting, along with medications that help control the heart rate.

However, when multiple medications are used together, they can sometimes interact in ways that cause harmful side effects. In the case of AFib, some patients may be more likely to experience severe bleeding depending on the combination of drugs they take.

What the Study Found

Researchers analyzed medical records of patients aged 65 and older who were enrolled in Medicare and had started treatment for AFib between 2012 and 2020. These patients were taking anticoagulants like apixaban or rivaroxaban(common blood thinners) along with diltiazem or metoprolol (drugs used to control heart rate).

The key finding was that patients taking diltiazem were 20% more likely to be hospitalized or die due to serious bleeding complications compared to those on metoprolol. The reason for this may be that diltiazem interacts with blood thinners in a way that makes the blood too thin, increasing the risk of dangerous bleeding.

Interestingly, the study did not find major differences in the risk of stroke or blood clots between the two groups. This means that while diltiazem may help control heart rate better than metoprolol, it may not be the safest option for all patients—especially older adults who are already more vulnerable to side effects.

Why Some People May Be at Higher Risk

According to Dr. Eli Zimmerman, a co-author of the study and an expert in stroke and heart conditions, the way medications are processed in the body varies from person to person. These differences are often linked to genetics, which can affect how well a drug works or how likely it is to cause side effects.

Since people with AFib often take multiple medications, understanding how their bodies react to these drugs is crucial in preventing complications like excessive bleeding.

What This Means for Patients

Doctors may need to monitor drug levels more closely in patients taking diltiazem and anticoagulants together. By tracking how an individual’s body responds to these medications, doctors could adjust dosages or choose alternative treatments to reduce the risk of bleeding.

For patients with AFib who are concerned about their treatment, it’s important to:

• Talk to your doctor about your medications and whether they increase your risk of bleeding.
• Be aware of symptoms of excessive bleeding, such as unexplained bruising, prolonged bleeding from cuts, or blood in the urine or stool.
• Follow a heart-healthy lifestyle to help manage blood pressure naturally. Reducing excess coffee intake, trying early time-restricted eating, and following a plant-based diet have been linked to improved blood pressure and overall heart health.

A More Personalized Approach to Treatment

This research highlights the importance of balancing risks and benefits when prescribing medications for AFib. While controlling heart rate is essential, choosing the safest medication is just as important.

As scientists continue to study why some people experience more side effects than others, the future of AFib treatment may move toward personalized care—where doctors tailor medications to each patient’s unique needs.

For now, patients and healthcare providers should work together to find the best and safest treatment approach, reducing the risk of complications while effectively managing atrial fibrillation.

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