Common blood pressure medication may increase the risk of bleeding

According to a study recently published in JAMA.

Atrial fibrillation is the most common type of irregular heart rhythm and can lead to blood clots or stroke if left untreated, according to the American Heart Association.

To prevent further complications from atrial fibrillation, people with the condition are often prescribed anti-clotting medications and medications to control the heart rate, said Eli Zimmerman, MD, associate professor in the Ken and Ruth Davee Department of Neurology in the Stroke Department. and Vascular Neurology. and a co-author of the study.

“Genetic differences can affect how different people metabolize medications. This is especially important when multiple medications used for the same condition, such as atrial fibrillation, are affected by these changes in metabolism,” said Zimmerman, who is also associate dean for student affairs. “Our research group has looked at these differences and how they can cause adverse effects.”

The study looked at health records from Medicare beneficiaries age 65 and older with atrial fibrillation who started taking the anticoagulant drugs apixaban or rivaroxaban in addition to diltiazem or metoprolol, drugs that slow the heart rate, between 2012 and 2020.

According to the study, patients taking diltiazem were 20% more likely to experience bleeding-related hospitalization and death. The risks were higher with higher doses of the drugs. According to the findings, there were no significant differences in the rates of stroke, systemic embolism, or hemorrhage.

“These are significant because they show that while there are some benefits of using diltiazem over metoprolol and vice versa, changes in metabolism may confer some increased bleeding risks in those taking diltiazem,” Zimmerman said.

Moving forward, Zimmerman said his research group will continue to investigate what causes different responses to the same medications and identify ways to potentially monitor drug levels.

“Next steps may include thinking about the need or practicality of monitoring drug levels, which is our putative mechanism of increased bleeding risk,” Zimmerman said.