Some medications can raise blood pressure, worsen heart failure, affect heart rhythm, or increase bleeding and cardiovascular complications in older adults. Learn about five medication groups worth reviewing with your doctor.
As we get older, medications can become an important part of staying healthy. Medicines may control blood pressure, cholesterol, diabetes, pain, sleep problems, arthritis, and many other conditions.
But aging also changes how the body processes medications. Kidney and liver function may decline, and older adults are more likely to take several medicines at the same time. This increases the possibility of drug interactions and side effects. The FDA specifically notes that older adults have a greater risk of drug-drug and drug-condition interactions.
That does not mean people should stop their medications. In fact, abruptly stopping certain heart, blood-pressure, or blood-thinning medicines can be dangerous.
Instead, some medication groups deserve particular attention because they can raise blood pressure, worsen heart failure, disturb heart rhythm, increase bleeding, or otherwise increase cardiovascular risk in susceptible older adults.
Here are five important categories to discuss with a healthcare professional.
1. NSAID Painkillers
Nonsteroidal anti-inflammatory drugs, commonly called NSAIDs, are widely used for arthritis, back pain, muscle pain, headaches, and other painful conditions.
Examples include:
- Ibuprofen
- Naproxen
- Diclofenac
- Indomethacin
- Meloxicam
- Ketorolac
These medications can be useful, but older adults may be more vulnerable to their adverse effects.
The American Geriatrics Society’s 2023 Beers Criteria notes that NSAIDs can increase blood pressure and cause kidney injury. They can also cause gastrointestinal bleeding, particularly in people over 75 or those taking anticoagulants, antiplatelet medicines, or corticosteroids.
Why does this matter for the heart?
An increase in blood pressure and fluid retention can place additional stress on the cardiovascular system. NSAIDs can also be particularly concerning in people who already have heart failure or kidney disease.
This doesn’t mean every older adult must avoid an NSAID. Rather, regular or long-term use should be reviewed with a healthcare professional, especially when someone already has cardiovascular or kidney problems.
2. Certain Decongestants
Some cold and sinus medications contain decongestants such as pseudoephedrine or phenylephrine.
These medicines can narrow blood vessels, which may raise blood pressure and increase the workload on the heart.
The FDA specifically warns that older adults may experience drug-condition interactions and gives nasal decongestants as an example of medicines that can cause problems in people with certain conditions such as high blood pressure.
This is particularly important during cold and flu season, when people may unknowingly take several products containing similar ingredients.
Before using an over-the-counter cold medicine, older adults with hypertension, heart disease, or other cardiovascular conditions should check the active ingredients and ask a pharmacist or doctor whether the product is appropriate.
3. Some Antipsychotic Medications
Antipsychotic medications are prescribed for several psychiatric and neurological conditions. Examples include risperidone, olanzapine, quetiapine, haloperidol, and others.
These medicines can be appropriate and sometimes essential for certain patients. However, they can also have important cardiovascular and neurological risks in older adults.
The 2023 AGS Beers Criteria identifies antipsychotics as medications requiring particular caution in older adults and notes cardiovascular-related concerns in specific circumstances. Some can contribute to low blood pressure when standing, increasing the risk of dizziness and falls.
Some antipsychotics can also affect heart rhythm, particularly in people with other risk factors or interacting medications.
Older adults should therefore have their medication list reviewed periodically rather than assuming that a medicine prescribed years ago remains appropriate indefinitely.
4. Certain Antidepressants and Other Medicines That Affect Heart Rhythm
Some medications can influence the electrical activity of the heart and, in susceptible people, contribute to abnormal heart rhythms.
This is especially relevant when an older person takes several medications simultaneously.
The risk can increase with factors such as:
- Existing heart disease
- Electrolyte abnormalities
- Kidney disease
- Older age
- Multiple medications that affect heart rhythm
- Certain drug combinations
Not every antidepressant carries the same risk, and many are used safely in older adults. The important point is that medication selection should consider the individual’s overall cardiovascular health.
The AGS Beers Criteria emphasizes that medication decisions in older adults should take into account drug interactions, underlying diseases, kidney function, and other individual factors rather than treating every medication as equally risky.
5. Systemic Estrogen and Certain Hormone Therapies
Hormone therapy requires individualized assessment, particularly as people get older.
Systemic estrogen—meaning estrogen that enters the bloodstream, such as oral or transdermal preparations—is different from low-dose vaginal estrogen used for local symptoms.
Hormone therapy may be appropriate for some people, but its benefits and risks depend heavily on age, medical history, timing, formulation, dose, and individual risk factors.
For this reason, older adults should not start, stop, or change hormone therapy without discussing it with their healthcare professional.
The AGS Beers Criteria includes systemic estrogen among medications requiring particular caution in older adults.
What About Aspirin?
Aspirin deserves special mention because many older adults take it believing that it automatically protects against heart attacks and strokes.
That is not true for everyone.
The 2023 AGS Beers Criteria recommends avoiding starting aspirin for primary prevention in older adults because the risk of major bleeding can outweigh the potential cardiovascular benefit. However, aspirin may still be appropriate for people who already have cardiovascular disease and are taking it for secondary prevention.
This distinction is extremely important.
Someone who has previously had a heart attack, certain types of stroke, or established cardiovascular disease may have a very different reason for taking aspirin than someone who has never experienced cardiovascular disease.
Therefore, nobody should stop prescribed aspirin without speaking with their healthcare professional.
Why Older Adults Need Extra Medication Reviews
Medication safety becomes more complicated with age for several reasons.
The kidneys and liver may process medicines differently, and older adults are more likely to take multiple medications. This increases the chance that one medicine will interfere with another.
The AGS Beers Criteria was specifically developed to help clinicians identify medications that may be inappropriate for older adults in particular situations. It includes medicines that should generally be avoided, medicines requiring caution, potentially dangerous drug combinations, and medicines requiring adjustment when kidney function is reduced.
Importantly, being listed in the Beers Criteria does not automatically mean a medication is dangerous for every older person.
The criteria are designed to support—not replace—individual clinical decision-making.
Warning Signs That Should Never Be Ignored
If an older adult taking any medication develops symptoms that could indicate a heart attack or stroke, seek emergency medical care.
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
- Sudden sweating
- Nausea or vomiting
- Unusual weakness or extreme fatigue
Possible stroke symptoms include:
- Sudden weakness or numbness, especially on one side
- Sudden difficulty speaking or understanding speech
- Sudden loss or change in vision
- Sudden severe dizziness or difficulty walking
- A sudden severe headache with no obvious cause
These symptoms require urgent evaluation rather than waiting to see whether they disappear.
Never Stop a Medication Suddenly
One of the most important messages for older adults is this:
Do not stop a prescribed medication simply because you read that it may carry a cardiovascular risk.
Some medications must be tapered gradually. Others prevent dangerous complications when taken correctly.
Instead, ask your doctor or pharmacist:
- Why am I taking this medication?
- Do I still need it?
- Is the dose appropriate for my age and kidney function?
- Could it raise my blood pressure or affect my heart?
- Does it interact with any of my other medicines?
- Is there a safer alternative for my particular situation?
A medication review can be especially useful when a person sees multiple doctors or takes several prescription and over-the-counter medicines.
The Bottom Line
There is no universal list of five medications that will cause a heart attack or stroke in every older person.
However, certain medication groups—including NSAID painkillers, some decongestants, certain antipsychotics, medications that can affect heart rhythm, and systemic hormone therapies—may require additional cardiovascular consideration depending on the individual’s health and other medications.
The safest approach is not fear or suddenly stopping treatment. It is regular medication review, careful dosing, checking for interactions, and making decisions based on the person’s individual risks and benefits.
For adults 65 and older, the American Geriatrics Society’s Beers Criteria can be a useful framework for clinicians when reviewing potentially inappropriate medications, but it should be used alongside the patient’s medical history and clinical judgment.