New research finds that a combination of low dose aspirin and beta-blockers reduces blood pressure and decreases symptoms of anxiety during bereavement. The findings could materialize into preventive measures that clinicians incorporate into their practices.
Dr. Geoffrey Tofler, a professor of preventive cardiology at the Faculty of Medicine and Health at the University of Sydney, in Australia, is the lead author of the new study.
He explains the motivation for the research, saying that the risk of mortality and adverse cardiovascular events is known to spike during bereavement.
Specifically: “The increased risk of heart attack [during bereavement] can last up to 6 months. It is highest in the first days following bereavement and remains at four times the risk between 7 days to 1 month after the loss,” the lead author notes.
In fact, in their paper — which appears in the American Heart Journal — the authors note that the risk of death following the loss of a loved one accounts for almost half of the excess mortality during the bereavement of a spouse.
Although the causes of cardiovascular risk during bereavement remain somewhat unclear, researchers believe that contributing factors can include higher systolic blood pressure and heart rate, lower heart rate variability, immune changes, and anxiety, depression, and anger.
Some previous studies, note Dr. Tofler and the team, have suggested that beta-blockers, aspirin, or both could modify physiological pathways that get activated in bereavement.
So, the researchers set out to test whether a low dosage of the beta-blocker metoprolol in combination with aspirin could lower the markers of cardiovascular risk without interfering with the grieving process.
Studying the effects of both drugs
To this end, Dr. Tofler and colleagues enrolled 85 participants who had lost either their spouse or a child in the past 2 weeks.
Of these participants, 42 took low daily doses of metoprolol and aspirin for 6 weeks, and the rest took a placebo.
The researchers asked the participants to take their blood pressure at home, accounting for the systolic measurements in the study.
The team also measured the participants’ 24-hour average heart rate, symptoms of anxiety and depression, and their blood clotting response — measured by the reaction of blood platelets to arachidonic acid.
In addition, the group assessed the intensity of each participant’s bereavement using the Core Bereavement Items questionnaire.
Benefits persist after treatment stops
“The main finding was that the active medication, used in a low dose once a day, successfully reduced spikes in blood pressure and heart rate, as well as demonstrating some positive change in blood clotting tendency,” reports Dr. Tofler.
He adds, “We were reassured that the medication had no adverse effect on the psychological responses and indeed lessened symptoms of anxiety and depression.”
Furthermore, “Encouragingly, and to our surprise,” the lead researcher continues, “reduced levels of anxiety and blood pressure persisted, even after stopping the 6 weeks of daily beta-blocker and aspirin.”
“Our study is the first clinical trial to examine how the cardiac risk factors could be mitigated during early bereavement,” continues the professor.
Improving the health of bereaved people
Co-author and associate professor Tom Buckley, Ph.D., says, “Our finding on the potentially protective benefit of this treatment is also a good reminder for clinicians to consider the well-being of the bereaved.”
“Future studies are needed to assess if these medications could be used for other short periods of severe emotional stress, such as after natural disasters or mass bereavement, where currently there are no guidelines to inform clinicians.”
Co-investigator Holly Prigerson, Ph.D., co-director of the Center for Research on End-of-Life Care, at Weill Cornell Medicine, in New York, also comments on the findings. She says, “This is an important study because it shows ways to improve the physical and mental health of at-risk bereaved people.”
“It is a preventive intervention that is potentially practice-changing, using inexpensive, commonly available medicines.”
– Holly Prigerson, Ph.D.
Finally, the authors caution that people should not take any of the medication studied in this trial without first discussing their symptoms with a physician, as incorrect use can be dangerous.
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