As we get older, medications can become an important part of managing blood pressure, diabetes, arthritis, heart disease, sleep problems, and many other conditions. But aging also changes how the body processes medicines. A drug that was well tolerated years ago may cause more side effects or interact differently with other medications later in life.
That does not mean older adults should stop taking prescribed medicines. In many cases, the benefits of a medication are much greater than its potential risks. The important issue is understanding which medicines may require extra caution, particularly in people who already have cardiovascular risk factors.
Here are five medication groups that doctors commonly review carefully in older adults because, depending on the drug, dose, duration, and individual health history, they can contribute to problems associated with heart attack or stroke.
1. NSAID Painkillers
Nonsteroidal anti-inflammatory drugs (NSAIDs) include medicines such as ibuprofen, naproxen, and diclofenac. They are widely used for headaches, arthritis, muscle pain, and inflammation.
Some NSAIDs can increase blood pressure, cause fluid retention, affect kidney function, and increase cardiovascular risk, particularly when used at higher doses or for longer periods.
For someone who already has:
- High blood pressure
- Heart disease
- Previous heart attack or stroke
- Kidney disease
- Heart failure
regular or prolonged NSAID use may deserve particular attention.
This doesn’t mean every older adult must avoid NSAIDs. A healthcare professional can help determine whether a particular painkiller, dose, and duration are appropriate.
2. Certain Decongestants
Some cold and allergy medicines contain decongestants such as pseudoephedrine or phenylephrine.
These medications can constrict blood vessels and may raise blood pressure or heart rate. For a healthy person using them briefly, this may not cause a major problem. However, older adults with uncontrolled hypertension, certain heart conditions, or cardiovascular disease may need to be more cautious.
The bigger issue is that decongestants can sometimes be hidden inside combination cold and flu products. Someone may accidentally take more than one product containing the same ingredient.
Always check the active ingredients before combining over-the-counter medicines.
3. Some Stimulant-Type Medications
Certain prescription medicines that stimulate the nervous system can increase heart rate and blood pressure.
The cardiovascular effects depend heavily on the specific medication and the person’s medical history. Older adults who have hypertension, an abnormal heart rhythm, coronary artery disease, or other cardiovascular problems may require closer monitoring.
These medicines should never be stopped suddenly or changed without medical advice.
If a medication causes persistent racing heartbeat, chest discomfort, fainting, or severe shortness of breath, medical attention is appropriate.
4. Some Hormone-Containing Medications
Certain hormone therapies can affect cardiovascular and blood-clotting risk. The risk varies considerably depending on the hormone, formulation, dose, route of administration, age, timing, and individual health factors.
For example, some systemic estrogen-containing therapies may increase the risk of blood clots and stroke in particular groups of women.
At the same time, hormone therapy can have legitimate medical uses, and the decision to use it should be individualized rather than based simply on age.
Anyone taking hormone-containing medication should periodically discuss whether the treatment remains appropriate.
5. Some Medications That Can Affect Heart Rhythm
A number of medications can influence the electrical activity of the heart. Some may prolong the QT interval or otherwise increase the risk of abnormal heart rhythms in susceptible people.
The risk can become greater when several medications with similar effects are taken together or when kidney or liver function changes the amount of medicine in the bloodstream.
This is one reason medication reviews become particularly important as people age.
Doctors and pharmacists may consider:
- The complete medication list
- Drug interactions
- Kidney and liver function
- Electrolyte levels
- Existing heart conditions
- Previous abnormal ECG results
Why Older Adults Need Medication Reviews
The biggest danger isn’t necessarily one particular medication. It can be the combination of several medicines, especially when prescriptions come from different doctors.
Older adults are more likely to experience changes in kidney function, body composition, metabolism, and sensitivity to medications. These changes can affect how strongly a drug works and how long it remains in the body.
A medication review can help identify:
- Duplicate medicines
- Potential drug interactions
- Unnecessary medications
- Doses that may need adjustment
- Over-the-counter medicines that could interfere with prescriptions
- Medicines that may increase blood pressure or bleeding risk
Don’t Stop a Medication on Your Own
A frightening headline about medication risks can tempt someone to stop taking a drug immediately. That can sometimes be more dangerous than the potential side effect being discussed.
For example, abruptly stopping certain heart, blood-pressure, seizure, psychiatric, or steroid medications can cause serious problems.
Instead, make a list of every medication and supplement you take, including over-the-counter products, and ask your doctor or pharmacist whether each one is still appropriate.
Know the Warning Signs of Heart Attack and Stroke
Medication safety is important, but recognizing emergencies is just as important.
Possible heart attack symptoms include:
- Pressure, squeezing, or pain in the chest
- Pain spreading to the arm, shoulder, back, neck, or jaw
- Shortness of breath
- Cold sweating
- Nausea or vomiting
- Unusual weakness or lightheadedness
Stroke warning signs can be remembered with FAST:
F — Face: One side of the face may droop.
A — Arm: One arm may become weak or numb.
S — Speech: Speech may become slurred or difficult to understand.
T — Time: Call emergency medical services immediately.
Sudden vision problems, severe dizziness, loss of balance, or a sudden severe headache can also require urgent evaluation.
The Bottom Line
Some medications can increase cardiovascular risks in certain older adults, but it is misleading to say that these medicines automatically cause heart attacks or strokes. The actual risk depends on the medication, dose, duration, combinations with other drugs, and the person’s underlying health.
The safest approach is not to fear medications or stop them without advice. Instead, older adults should have their medication lists reviewed regularly and should ask their doctor or pharmacist about potential interactions and cardiovascular risks.
A medication that is appropriate for one person may not be appropriate for another. Personalized medical advice is especially important when treating older adults with multiple health conditions.