Hypertension Can Increase Likelihood and Severity of Nosebleeds

In a new study, scientists have found that patients with hypertension have an increased risk of nosebleeds that require emergency hospital visits. The study was published in the Journal of American Medical Association (Otolaryngology–Head & Neck Surgery).

The researchers found that compared with patients without hypertension, those with hypertension appeared to have an increased risk of nosebleeds, had more emergency department visits, and required more posterior nasal packing procedures.

Why is this finding important? A nasal packing procedure is not without its complications. First, in many cases patients who have their nose packed have to come back to the hospital to get the packing removed.

Secondly, the packing can cause serious issues like abscesses, septal hematomas, sinusitis, and pressure necrosis. In some rarer instances toxic shock syndrome can also occur with prolonged nasal packing. Toxic shock syndrome that occurs due to pathogens such as bacteria can be life threatening at times.

Previously, the association between high blood pressure and nosebleeds has long been a subject of debate. In this study, the scientists used a nationwide population cohort to check the risk of nosebleeds in patients with hypertension and to see if there is an association of hypertension with the methods of managing cases of nosebleeds.

The data was taken from the Korean National Health Insurance Service–National Sample Cohort that represents the entire population of the Republic of Korea from January 1, 2002, to December 31, 2015. The hypertension cohort comprised 35 749 patients with a record of 3 or more prescriptions of antihypertensive medication and a diagnosis of hypertension. An equal number of people without hypertension were included in the study, for comparison.

Patients with other diseases associated with epistaxis, such as sinonasal tumors, facial trauma, bleeding tendency, and coagulation disorder, as well as those taking anticoagulant medications, were excluded.

The study comprised of both men and women with an average age of 52 years. The incidence of nosebleeds was 32.97 per 10 000 persons, in the hypertension cohort. The incidence of nosebleeds in non-hypertension cohort was 22.76 per 10 000 persons.

The incidence of recurrent nosebleeds was 1.96 per 10 000 persons in the hypertension cohort and 1.59 per 10 000 persons in the non-hypertension cohort.

Subjects with hypertension who experienced nosebleeds were more likely to use the emergency department (odds ratio: 2.69) and receive posterior nasal packing (odds ratio: 4.58) compared with the comparison cohort.

The researchers conducting the study suggest that medical counseling about nosebleeds should be given to individuals with hypertension. Authors say that chronic vascular damage could play a role in the observed association and advice that “the presence of hypertension should be considered when managing nasal bleeding.”

If you suffer from a nosebleed, here are few things you should try before seeking medical care:

  • Sit up straight which will help reduce blood pressure in the veins of your nose. This will help stop further bleeding and help you avoid swallowing blood, which can irritate your stomach.
  • Pinch your nose. Pinching will send pressure to where bleeding is occurring and stop the blood flow.

You should consider, seeking medical care if the bleeding lasts more than 20 minutes or you feel faint or lighthearted. If the nosebleed occurs post fall or a physical injury, immediately reach the emergency department.

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