Pathogenesis of nasal bleeding in the patients presenting with arterial hypertension

Abstract

The objective of the present work was to study the pathogenetic mechanisms underlying nasal bleeding (NB) in the patients presenting with arterial hypertension (AH). A total of 47 patients with AH suffering from NB were available for the examination of whom 28 experienced a single bleeding episode and 19 had recurrent bleeding. 11 of them were treated by endonasal surgical intervention for the achievement of hemostasis. Simultaneously, mucoperichondreal biopsies were taken from the anterior septal portions and used for histological and ultrastructural investigations. The laboratory examination of all the patients has demonstrated hyperfibrinogenemia and the enhanced level of soluble monomeric fibrin complexes in the blood (especially in the patients with recurrent nasal bleeding) despite the normal platelet levels, prothrombin and thrombin times. These findings gave reason to characterize the hemostasiological status of the patients as chronic compensated disseminated intravascular coagulation (DIC) syndrome. The histological study revealed hyaline, erythrocyte-rich and fibrin thrombi in the vessels of the microcirculatory system whereas ultrastructural studies showed desquamation of endothelial cells, massive desendothelization, and disintegration of the basal membrane with the exposure of subendothelium. It is supposed that these changes provoked the development of thrombosis and focal necrosis in nasal mucosa. The authors conclude that the cause of nasal bleeding associated with arterial hypertension is directly related to the lesions of vascular endothelial, microcirculatory disorders, and modification of the blood coagulation processes rather than to the mechanical rupture of blood vessels. These changes are believed to be responsible for the development of local intravascular coagulation.

Association between hypertension and gingival bleeding: a two-sample Mendelian randomization study

“…Periodontal microorganisms may directly invade the arterial wall, leading to vascular in ammation and atherosclerosis [36]. At the same time, the causes of vascular bleeding due to hypertension are directly related to endothelial lesions, microcirculatory disorders and alterations in the coagulation process, rather than to mechanical rupture of blood vessels, and these changes are thought to be responsible for the development of local intravascular coagulation [37]. Conversely, there are studies that do not support the link, with one nding that periodontal pockets and bleeding gums do not appear to be associated with high blood pressure in non-diabetic, non-smokers aged 30-49 years [38].…”

Diastolic blood pressure achieved at target systolic blood pressure (120-140 mmHg) and dabigatran-related bleeding in patients with nonvalvular atrial fibrillation: a real-world study

“…Another study reported that hypertension increased platelet aggregation and activity, thereby activating the fibrinolytic system, which led to increased bleeding risk ( 19 ). A study also found that hypertension was directly related to vascular endothelial lesions, microcirculatory disorders, and modification of the blood coagulation processes ( 20 ). In addition, 24 patients had adverse bleeding events in the DBP <80 mm Hg group.…”

Incidence of Nasal Bacterial Colonization in Children with Recurrent Epistaxis

“…Превалирующие причины возникновения НК зависят от возраста пациента. Если у взрослых это артериальная гипертензия [8], то у детей НК чаще всего возникают в результате острой респираторной вирусной инфекции (ОРВИ) и сопряженного с ней приема нестероидных противовоспалительных препаратов [9] или пальцевой травмы на фоне образования корок в носу [1].…”