# The Relationship Between Epistaxis and Stages of Hypertension: A Prospective Observational Study of 250 Cases in Emergency Medicine

## TL;DR

This study found that higher stages of hypertension are linked to more severe and recurring nosebleeds, especially posterior epistaxis, in emergency patients.

## Contribution

The study provides new evidence that stage 2 hypertension is an independent predictor of posterior and recurrent epistaxis.

## Key findings

- Stage 2 hypertension was significantly associated with posterior epistaxis (p < 0.001).
- Stage 2 hypertension was an independent predictor of recurrent epistaxis (OR = 3.4).
- Severe epistaxis episodes were more frequent in patients with stage 2 hypertension.

## Abstract

Introduction: Epistaxis is one of the most common nasal health emergency presentations and is frequently associated with systemic hypertension. As the exact relationship between various stages of hypertension and epistaxis severity and frequency remains poorly defined, in this study we aimed to evaluate the correlation between stages of hypertension and the incidence, type, and severity of epistaxis among patients presenting to the emergency department.

Methods: A prospective observational study was carried out over 12 months in the casualty department of a tertiary care hospital in India in which a total of 250 patients with epistaxis were evaluated for their status of blood pressure and history of hypertension. Blood pressure was classified per the American Heart Association (AHA) guidelines into normal, elevated, stage 1, and stage 2 hypertension. Variables including the type of epistaxis (anterior vs posterior), recurrence, severity, and required interventions were recorded and statistically analyzed using SPSS software version 27 (IBM Corp., Armonk, NY, USA).

Results: Among 250 patients, 48% (120 patients) had stage 2 hypertension, 30% (75 patients) had stage 1, 15% (38 patients) had elevated blood pressure, and 7% (17 patients) had normal readings. Posterior epistaxis was significantly more common in stage 2 hypertensive patients (p < 0.001). Recurrent and severe episodes were also more frequent in stage 2. Multivariate analysis indicated stage 2 hypertension as an independent predictor for posterior and recurrent epistaxis (OR = 3.4, 95% CI = 2.1-5.2).

Conclusion: There is a significant correlation that exists between the severity of hypertension and the type and recurrence of epistaxis. Patients with stage 2 hypertension are at higher risk of developing recurrent nasal bleeding episodes and may need aggressive management.