Is epistaxis associated with arterial hypertension? A systematic review of the literature

Abstract

Both epistaxis and hypertension are frequent problems in the adult population. The relationship between the level of arterial pressure and incidence of epistaxis in a patient with hypertension is a question that appears frequently in the clinical practice. A systematic review of the literature regarding the relation of arterial hypertension with epistaxis was performed through MEDLINE and EMBASE. All studies, whether examining the correlation of arterial pressure at presentation of a patient with nasal bleeding or the repercussion of episodes of epistaxis in hypertensive patients, were included in this review. Studies were evaluated independently by two reviewers according to a standard evaluation form. Overall, nine studies fulfilled our inclusion criteria. Five of them were single-group (patient) studies, while the remaining four included a control group. In eight studies, the patient group included patients with epistaxis, while one focused on hypertensive patients. Six out of nine studies agree that arterial pressure is higher at the time of epistaxis, as compared to the control group or to the general population. Seven out of nine studies conclude that there is cross-correlation between arterial pressure and the actual incident of epistaxis. The presence of high arterial blood pressure during the actual episode of nasal bleeding cannot establish a causative relationship with epistaxis, because of confounding stress and possible white coat phenomenon, but may lead to initial diagnosis of an already installed arterial hypertension.

Seasonal variation and predictors of epistaxis

“…Many previous studies have attempted to establish this association, but they have found conflicting results. A recent systematic review was unable to reach a consensus based on the available literature . In our analysis, the association between HTN and epistaxis was significant.…”

The role of oral anticoagulants in epistaxis

“…Preexisting arterial hypertension was seen as a confounder and has also been associated with epistaxis in multiple publications [10, 21, 22]. Our number is significantly higher compared to epidemiologic studies which demonstrated a 35–40% prevalence for people above the age of 35 although the steep increase of numbers with age has to be taken into account for our cohort [23].…”

Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial

“…Most published studies indicate that patients who present with epistaxis have higher blood pressure than controls without epistaxis (37), but it is unclear whether this difference represents actual underlying hypertension (38). Patients with higher blood pressure may also have more severe episodes and require more invasive interventions (39).…”