The relationship between hypertension and epistaxis is often misunderstood. Patients with epistaxis commonly present with an elevated blood pressure. Epistaxis is more common in hypertensive patients, perhaps owing to vascular fragility from long-standing disease.
Hypertension, however, is rarely a direct cause of epistaxis. More commonly, epistaxis and the associated anxiety cause an acute elevation of blood pressure. Therapy, therefore, should be focused on controlling hemorrhage and reducing anxiety as primary means of blood pressure reduction.
A study by Sarhan and Algamal, which included 40 patients with epistaxis and 40 controls, reported that the number of attacks of epistaxis was higher in patients with a history of hypertension, but the investigators were unable to determine whether a definite link existed between nosebleeds and high blood pressure. They did find, however, that control of epistaxis was more difficult in hypertensive patients; patients whose systolic blood pressure was higher at presentation tended to need management with packing, balloon devices, or cauterization. [14]
Excessive coughing causing nasal venous hypertension may be observed in pertussis or cystic fibrosis.
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Posterior epistaxis from the left sphenopalatine artery.
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Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
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Nasal speculum.
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Vaseline gauze packing.
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Expandable (Merocel) packing (dry).
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Nasal vascular anatomy
