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High blood pressure was linked to a higher risk and severity of nosebleeds, a population-based study showed.

Epistaxis requiring clinical care occurred in 32.97 per 10,000 hypertensive patients, compared with 22.76 per 10,000 matched controls without high BP (adjusted HR 1.47, 95% CI 1.30-1.66), according to Jae Ho Chung, MD, PhD, of Hanyang University School of Medicine in Seoul, and colleagues.

Among those who experienced epistaxis, patients with hypertension were more likely to visit the emergency department (OR 2.69, 95% CI 1.70-4.25) and receive posterior nasal packing (OR 4.58, 95% CI 1.03-20.38) compared with controls.

"To our knowledge, the present study is the first to assess the association between hypertension and epistaxis using a nationwide population-based cohort. The results suggest that hypertension may be a risk factor for epistaxis," the group wrote in their paper published online in .

The link has , they noted, with some suggesting hypertension is not a risk factor but "a physiologic response to nasal bleeding followed by an adrenergic effect."

"Medical counseling about epistaxis is advisable for individuals with hypertension, and the presence of hypertension should be considered in managing nasal bleedings," Chung and colleagues concluded. Epistaxis may rarely be life-threatening, but it requires appropriate treatment when it happens, especially in elderly patients with cardiovascular disease, the investigators noted.

One question now is whether successful management of hypertension can reduce the incidence and severity of epistaxis.

The retrospective study drew upon the Korean National Health Insurance Service–National Sample Cohort. Patients in the hypertension cohort (57.6% men, median age 52 years) were matched 1:1 to a comparison cohort (58.5% men, median age 52 years), with 35,759 people in each group. Individuals were followed for a median of 5.5 years.

Hypertension was defined as having a record of three or more prescriptions of antihypertensive medication and a diagnosis of hypertension.

Patients with other conditions associated with nosebleeds (e.g., sinonasal tumor, facial trauma, coagulation disorder) were excluded from the study.

Repeated episodes of epistaxis (occurring more than 90 days after a prior treatment of epistaxis) were observed in 1.96 per 10,000 persons in the hypertension cohort and 1.59 per 10,000 control patients -- not a statistically significant difference between groups.

"It is still theoretically possible, however, that recurrence of epistaxis may be higher for patients with hypertension, which could not be assessed in this study owing to the limitation of public claims data," study authors wrote.

Their dataset lacked detailed clinical information on severity of hypertension, patient adherence, specific bleeding foci, amount of bleeding, and evaluation of successful management.

The study also did not include patients with nosebleeds minor enough to skip a visit to the doctor's office or hospital, Chung's team cautioned.

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