HYPERTENSION AND NOSEBLEEDS (EPISTAXIS)

ARE THEY RELATED?

We all know from personal experience that nosebleeds are very common. Many of us and our friends had it, often with no reason at all. It usually stops by itself or with a gentle squeeze of external finger pressure on the nose. However, sometimes rather severe, long lasting nosebleeds could also occur and usually requires professional help, with either posterior nasal packing or cautery of the bleeding vessel in the nasal cavity.

Most think that elevated blood pressure is the main cause of nosebleed in adults and in elderly population, but this relationship never been studied and documented.

A recent, interesting large Korean retrospective clinical study tried to address this issue. Researchers, using “National Health Insurance” data, created two large group of adult patients (medium age of 52) with 36,000 patients in each group, to compare the incidence of nosebleeds. One group with drug treated hypertension, the other group with normal blood pressure. During a medium follow up period of 6 years, the incidence of nosebleed (epistaxis) was significantly higher in the hypertensive group than the control group (33 vs 23 per 1000 patients). Epistaxis was more severe in hypertensive group; 13% sought hospital care, while only 5% in the normotensive group needed hospital care.

However, it is not clear from this study whether or not severe epistaxis was related to markedly elevated blood pressure. So, we still don’t know why nosebleed incidence is much higher in hypertensive patients. Is it due to elevated blood pressure and it works like pressure valve, or is it just due to vascular fragility induced by chronic hypertension?

As I See It, maybe epistaxis is the body’s defense mechanism in hypertension. Maybe it works like a safety valve to reduce elevated blood pressure.