How does hypertension contribute to epistaxis. When does a nosebleed require immediate medical attention. What are the best methods to stop a nosebleed at home. How much blood loss from a nosebleed is considered dangerous.

The Link Between Hypertension and Nosebleeds

Hypertension, or high blood pressure, is often associated with an increased risk of nosebleeds (epistaxis). This connection stems from the physiological effects of elevated blood pressure on the delicate blood vessels in the nasal cavity.

High blood pressure can cause the blood vessels in the nose to become more fragile and prone to rupture. When these weakened vessels are exposed to triggers like dry air, irritants, or minor trauma, they’re more likely to break and result in a nosebleed.

Additionally, hypertension can lead to changes in blood viscosity and coagulation factors, potentially exacerbating bleeding once it starts. This combination of factors explains why individuals with uncontrolled hypertension may experience more frequent or severe nosebleeds compared to those with normal blood pressure.

Key Factors Linking Hypertension and Nosebleeds:

• Increased fragility of nasal blood vessels
• Changes in blood viscosity
• Altered coagulation factors
• Greater susceptibility to environmental triggers

Common Causes of Nosebleeds Beyond Hypertension

While hypertension can contribute to nosebleeds, it’s important to recognize that many other factors can also trigger epistaxis. Understanding these diverse causes can help individuals better manage and prevent nosebleeds.

Environmental Factors:

• Dry air (especially in winter or arid climates)
• Low humidity
• Exposure to irritants (e.g., smoke, chemicals)

Medical Conditions:

• Sinusitis
• Allergies
• Blood disorders (e.g., hemophilia, von Willebrand disease)
• Liver disease

Medications and Substances:

• Blood-thinning medications (e.g., aspirin, warfarin)
• Nasal sprays (overuse can dry out nasal membranes)
• Alcohol consumption

Physical Factors:

• Trauma to the nose
• Nose picking
• Deviated septum

Recognizing these various causes can help individuals identify potential triggers and take appropriate preventive measures to reduce the frequency of nosebleeds.

Recognizing Emergency Signs in Nosebleeds

While most nosebleeds are benign and can be managed at home, certain situations require immediate medical attention. Recognizing these emergency signs is crucial for ensuring prompt and appropriate care.

Duration of Bleeding

Can a prolonged nosebleed indicate a serious problem? Yes, if a nosebleed persists for more than 20 minutes despite applying proper first aid techniques, it may signal a more significant issue. Continuous bleeding beyond this timeframe could indicate an underlying medical condition or a failure of normal clotting mechanisms.

Volume of Blood Loss

How much blood loss is considered dangerous during a nosebleed? While it can be challenging to accurately gauge blood loss, a general rule of thumb is that losing more than 1 cup (237 ml) of blood is cause for concern. Excessive blood loss can lead to lightheadedness, weakness, and in severe cases, shock.

Additional Emergency Signs:

• Difficulty breathing or swallowing
• Chest pain or palpitations
• Altered mental status or confusion
• Pale or clammy skin
• Nosebleeds following a head injury

If any of these emergency signs are present, it’s crucial to seek immediate medical attention by calling emergency services or going to the nearest emergency room.

Effective Home Management of Nosebleeds

For most uncomplicated nosebleeds, proper home management can effectively stop the bleeding and prevent complications. Understanding the correct techniques is essential for quick resolution.

Step-by-Step Guide to Stopping a Nosebleed:

1. Sit upright and lean slightly forward to prevent blood from flowing down the throat.
2. Pinch the soft part of the nose firmly with the thumb and index finger.
3. Breathe through the mouth and maintain pressure for 10-15 minutes without interruption.
4. Apply a cold compress or ice pack to the bridge of the nose to constrict blood vessels.
5. After 15 minutes, gently release pressure. If bleeding persists, repeat the process.

Common Mistakes to Avoid:

• Lying down or tilting the head back
• Blowing the nose forcefully
• Inserting tissues or other materials into the nostrils
• Frequently checking if the bleeding has stopped before the recommended time

By following these steps and avoiding common pitfalls, most individuals can effectively manage nosebleeds at home. However, if bleeding persists or recurs frequently, consulting a healthcare professional is advisable.

The Role of Blood-Thinning Medications in Nosebleeds

Blood-thinning medications, also known as anticoagulants or antiplatelet drugs, play a significant role in the occurrence and management of nosebleeds. These medications are commonly prescribed for various cardiovascular conditions but can increase the risk and severity of epistaxis.

Common Blood-Thinning Medications:

• Aspirin
• Warfarin (Coumadin)
• Clopidogrel (Plavix)
• Apixaban (Eliquis)
• Rivaroxaban (Xarelto)

Do blood-thinning medications increase the risk of nosebleeds? Yes, these medications work by interfering with the blood’s clotting ability, which can make it more challenging to stop bleeding once it starts. This effect is particularly noticeable in areas with delicate blood vessels, such as the nasal cavity.

Managing Nosebleeds While on Blood Thinners:

1. Inform your healthcare provider about frequent nosebleeds.
2. Follow prescribed dosages carefully.
3. Consider using a humidifier to prevent nasal dryness.
4. Apply saline nasal sprays or gels to keep nasal passages moist.
5. Be extra cautious to avoid nasal trauma.

For individuals on blood thinners, it’s crucial to consult with a healthcare provider about specific strategies to manage and prevent nosebleeds. In some cases, adjustments to medication dosages or additional preventive measures may be necessary.

Preventive Measures for Reducing Nosebleed Frequency

While not all nosebleeds can be prevented, implementing certain lifestyle changes and preventive measures can significantly reduce their frequency and severity. These strategies are particularly important for individuals with recurring nosebleeds or those at higher risk due to medical conditions or medications.

Environmental Modifications:

• Use a humidifier to add moisture to the air, especially in dry climates or during winter months.
• Avoid excessive heat from heaters or air conditioners that can dry out nasal passages.
• Consider using an air purifier to reduce exposure to irritants and allergens.

Nasal Care Practices:

• Apply a thin layer of petroleum jelly inside the nostrils using a cotton swab.
• Use saline nasal sprays or gels to keep nasal passages moist.
• Avoid picking or blowing the nose forcefully.
• Use a soft tissue to gently blow the nose when necessary.

Lifestyle Adjustments:

• Stay hydrated by drinking plenty of water throughout the day.
• Limit alcohol consumption, as it can contribute to dehydration and blood vessel dilation.
• Quit smoking or avoid second-hand smoke, which can irritate nasal passages.
• Manage allergies effectively with appropriate medications or treatments.

Medical Considerations:

• Control high blood pressure through medication and lifestyle changes as recommended by a healthcare provider.
• Discuss potential medication adjustments with a doctor if nosebleeds are frequent and severe.
• Consider using over-the-counter nasal corticosteroid sprays to reduce inflammation (under medical guidance).

By implementing these preventive measures, many individuals can significantly reduce the frequency and severity of nosebleeds. However, it’s important to remember that persistent or severe nosebleeds should always be evaluated by a healthcare professional to rule out underlying medical conditions.

When to Seek Professional Medical Care for Nosebleeds

While most nosebleeds can be managed at home, certain situations warrant professional medical attention. Recognizing these scenarios is crucial for ensuring appropriate care and preventing potential complications.

Frequency and Severity:

Should frequent nosebleeds always be evaluated by a doctor? Yes, if you experience nosebleeds more than once a week or if they are particularly severe, it’s advisable to consult a healthcare provider. Frequent nosebleeds may indicate an underlying condition that requires treatment.

Situations Requiring Immediate Medical Attention:

• Nosebleeds lasting longer than 30 minutes despite proper first aid
• Heavy blood loss leading to lightheadedness or fainting
• Nosebleeds accompanied by other symptoms such as high fever, chest pain, or difficulty breathing
• Bleeding that interferes with breathing or swallowing
• Nosebleeds following a head injury or significant facial trauma

High-Risk Individuals:

Certain groups of people should have a lower threshold for seeking medical care for nosebleeds:

• Individuals on blood-thinning medications
• Those with known bleeding disorders
• People with uncontrolled hypertension
• Elderly individuals, particularly those with multiple medical conditions
• Children with recurrent or severe nosebleeds

What to Expect During a Medical Evaluation:

1. Detailed medical history, including frequency and circumstances of nosebleeds
2. Physical examination of the nose and nasal passages
3. Possible blood tests to check for clotting disorders or anemia
4. In some cases, imaging studies like CT scans or nasal endoscopy

Seeking timely medical care when necessary can help identify underlying causes, prevent complications, and provide appropriate treatment for persistent or severe nosebleeds. Healthcare providers can offer tailored advice and interventions based on individual circumstances and medical history.

How does hypertension cause epistaxis (nosebleed)?

Author

Quoc A Nguyen, MD Associate Clinical Professor, Director, Sinus and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Medical Center

Quoc A Nguyen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, Phi Beta Kappa, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, The Triological Society, American Rhinologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children’s Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;The Physicians Edge;Sync-n-Scale;mCharts<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa;Proforma;Neosoma<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; .

Additional Contributors

Hassan H Ramadan, MD, MSc, FACS, FARS Professor and Chairman, Director of Rhinology and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc, FACS, FARS is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society

Disclosure: Nothing to disclose.

When a Bloody Nose Becomes an Emergency?

Bloody noses are common and can be caused by a variety of factors including dehydration, cold, dry air, sinusitis, allergies, blood-thinning medications, and trauma. More often than not a combination of these factors is to blame. For example, you’ll be more likely to get a bloody nose after accidentally bumping it if you’re already dehydrated or suffering from sinus problems.

That said, usually, a bloody nose is nothing to worry about but there also are situations in which a bloody nose is a medical emergency and should be tended to right away. Here’s a quick guide to both situations. Read past the chart for more details.

Illustration by Brianna Gilmartin, Verywell

Nose Bleeding Nonstop for 20 Minutes

For most healthy individuals you should be able to stop a bloody nose at home in about 20 minutes or less. Leaning slightly forward and gently pinching your nostrils together should do the trick. If you have a bleeding disorder it may take longer.

You should talk to your doctor about methods and wait times when it comes to bloody noses if you’re on blood-thinning medications or have a condition such as hemophilia.

You’re Losing Too Much Blood

Too much blood loss can make a bloody nose an emergency. Medical professionals will often say that 5 milliliters of blood look like 30. It’s true if you’re judging by the amount of blood on your shirt, it may look like you need a transfusion when you’ve really lost no more than a few tablespoons. If you’re gushing blood, however, you need to call 911.

The best thing to do when you get a bloody nose is to lean slightly forward and gently pinch your nostrils together with a clean tissue. This facilitates clotting.

If it’s still dripping, however, grab a container to catch the blood. If possible this container should be a measuring cup. This allows you to accurately describe your blood loss to medical personnel.

Blood loss will be of most concern if you have a history of blood diseases such as anemia, hemophilia, or if you have been taking medications that thin the blood such as aspirin, Coumadin (warfarin), or Lovenox.

How much blood is acceptable to lose? That depends on your overall health and whether you’re having symptoms of anemia. It’s best to consult your doctor with a good idea of how much blood you’ve actually lost.

Symptoms of too much blood loss (anemia) include:

• Fatigue
• Feeling dizzy or light-headed
• Pale skin color
• Confusion
• Rapid heartbeat
• Chest pain

If you have experienced any of the symptoms above, you should call 911, go to the emergency department or consult your doctor immediately.

Bloody Nose Caused by Severe Trauma

Trauma, especially a blow to the head, can make a bloody nose an emergency. We’ve all been bumped in the nose, or fallen down and gotten a minor bloody nose, but that’s not severe trauma.

If you’ve fallen down the stairs, collided with another individual, been in a skiing accident, fight, or other traumatic incidents that have resulted in a bloody nose, you could have a very serious medical emergency on your hands.

What starts out as a bloody nose, with a little bit of time and swelling, may soon make it almost impossible to breathe. That’s not even to mention possible fractures (ie. broken nose), concussion, or spinal cord injury. Just do yourself a favor and get some emergency medical care.

High Blood Pressure May Be the Cause

A bloody nose becomes an emergency when it is caused by high blood pressure. In this case, the nosebleed will come on spontaneously. If this occurs, especially if you have a history of high blood pressure, or if the bloody nose is accompanied by a pounding headache or mental confusion, contact your doctor. 

You Can Taste Blood

Bloody noses towards the front of the nose are usually less severe and can be stopped with pressure. However, if you can taste blood, you likely have a posterior bleed (located towards the back of the nose).

Posterior nosebleeds tend to be more severe and cannot be stopped by pinching your nostrils. These tend to be related to major blood vessels, so you should go to the emergency department immediately.

Types, Causes, Treatment & Prevention

Overview

A nosebleed occurs when blood vessels lining the nose get injured and bleed.

What is a nosebleed?

Simply put, a nosebleed is the loss of blood from the tissue that lines the inside of your nose.

Nosebleeds (also called epistaxis) are common. Some 60% of people will have at least one nosebleed in their lifetime. The location of the nose in the middle of the face and the large number of blood vessels close to the surface in the lining of your nose make it an easy target for injury and nosebleeds.

Are nosebleeds serious?

Although seeing blood coming out of your noise can be alarming, most nosebleeds are not serious and can be managed at home. Some, however, should be checked by your doctor. For instance, if you have frequent nosebleeds, see your doctor. This could be an early sign of other medical problems that needs to be investigated. A few nosebleeds start in the back of the nose. These nosebleeds usually involve large blood vessels, result in heavy bleeding and can be dangerous. You will need medical attention for this type of bleed, especially if the bleeding occurs after an injury and the bleeding hasn’t stopped after 20 minutes of applying direct pressure to your nose. (Read on to learn the steps for how to stop a nosebleed.)

Are there different kinds of nosebleeds?

Yes. Nosebleeds are described by the site of the bleed. There are two main types and one is more serious than the other.

An anterior nosebleed starts in the front of the nose on the lower part of the wall that separates the two sides of the nose (called the septum). Capillaries and small blood vessels in this front area of the nose are fragile and can easily break and bleed. This is the most common type of nosebleed and is usually not serious. These nosebleeds are more common in children and are usually able to be treated at home.

A posterior nosebleed occurs deep inside the nose. This nosebleed is caused by a bleed in larger blood vessels in the back part of the nose near the throat. This can be a more serious nosebleed than an anterior nosebleed. It can result in heavy bleeding, which may flow down the back of the throat. You may need medical attention right away for this type of nosebleed. This type of nosebleed is more common in adults.

Who gets nosebleeds?

Anyone can get a nosebleed. Most people will have at least one in their lifetime. However, there are people who are more likely to have a nosebleed. They include:

• Children between ages two and 10. Dry air, colds, allergies and sticking fingers and objects into their nose make children more prone to nosebleeds.
• Adults between ages 45 and 65. Blood may take longer to clot in mid-life and older adults. They are also more likely to be taking blood thinning drugs (such as daily aspirin use), have high blood pressure, atherosclerosis (hardening of the walls of arteries) or a bleeding disorder.
• Pregnant women. Blood vessels in the nose expand while pregnant, which puts more pressure on the delicate blood vessels in the lining of the nose.
• People who take blood-thinning drugs, such as aspirin or warfarin.
• People who have blood clotting disorders, such as hemophilia or von Willebrand disease.

Symptoms and Causes

What causes nosebleeds?

Nosebleeds have many causes. Fortunately, most are not serious.

The most common cause of nosebleeds is dry air. Dry air can be caused by hot, low-humidity climates or heated indoor air. Both environments cause the nasal membrane (the delicate tissue inside your nose) to dry out and become crusty or cracked and more likely to bleed when rubbed or picked or when blowing your nose.

Other common causes of nosebleeds include:

• Nose picking.
• Colds (upper respiratory infections) and sinusitis, especially episodes that cause repeated sneezing, coughing and nose blowing.
• Blowing your nose with force.
• Inserting an object into your nose.
• Injury to the nose and/or face.
• Allergic and non-allergic rhinitis (inflammation of the nasal lining).
• Blood-thinning drugs (aspirin, non-steroidal anti-inflammatory drugs, warfarin, and others).
• Cocaine and other drugs inhaled through the nose.
• Chemical irritants (chemicals in cleaning supplies, chemical fumes at the workplace, other strong odors).
• High altitudes. The air is thinner (lack of oxygen) and drier as the altitude increases.
• Deviated septum (an abnormal shape of the wall that separates the two sides of the nose).
• Frequent use of nasal sprays and medications to treat itchy, runny or stuffy nose. These medications – antihistamines and decongestants – can dry out the nasal membranes.

Other, less common causes of nosebleeds include:

Management and Treatment

To stop a nosebleed, lean your head slightly forward and pinch the soft part of the nose against the hard bony ridge that forms the bridge of your nose.

How do I stop a nosebleed?

Follow these steps to stop a nosebleed:

• Relax.
• Sit upright and lean your body and your head slightly forward. This will keep the blood from running down your throat, which can cause nausea, vomiting, and diarrhea. (Do NOT lay flat or put your head between your legs.)
• Breathe through your mouth.
• Use a tissue or damp washcloth to catch the blood.
• Use your thumb and index finger to pinch together the soft part of your nose. Make sure to pinch the soft part of the nose against the hard bony ridge that forms the bridge of the nose. Squeezing at or above the bony part of the nose will not put pressure where it can help stop the bleeding.
• Keep pinching your nose continuously for at least 5 minutes (timed by clock) before checking if the bleeding has stopped. If your nose is still bleeding, continue squeezing the nose for another 10 minutes.
• If you’d like, apply an ice pack to the bridge of your nose to further help constrict blood vessels (which will slow the bleeding) and provide comfort. This is not a necessary step, but you can try this if you want.
• You can spray an over-the-counter decongestant spray, such as oxymetazoline (Afrin®, Dristan®, Neo-Synephrine®, Vicks Sinex®, others) into the bleeding side of the nose and then apply pressure to the nose as described above. WARNING: These topical decongestant sprays should not be used over a long period of time. Doing so can actually cause an increase in the chance of a nosebleed.
• After the bleeding stops, DO NOT bend over, strain and/or lift anything heavy. DO NOT blow or rub your nose for several days.

When should I go to the emergency room if I have a nosebleed?

Call your doctor immediately or have someone drive you to the nearest emergency room or call 911 if:

• You cannot stop the bleeding after more than 15 to 20 minutes of applying direct pressure on your nose as described in the steps above.
• The bleeding is rapid or the blood loss is large (more than a cup).
• You are having difficulty breathing.
• You have vomited because you’ve swallowed a large amount of blood.
• Your nosebleed has followed a blow to your head or serious injury (fall, car accident, smash to your face or nose).

Call your doctor soon if:

• You get nosebleeds often.
• You have symptoms of anemia (feeling weak or faint, tired, cold, short of breath, pale skin).
• You have a child under two years of age who has had a nosebleed.
• You are taking blood thinning drugs (such as aspirin or warfarin) or have a blood clotting disorder and the bleeding won’t stop.
• You get a nosebleed that seems to have occurred with the start of a new medication.
• You get nosebleeds as well as notice unusual bruising all over your body. This combination may indicate a more serious condition such as a blood clotting disorder (hemophilia or von Willebrand disease), leukemia or nasal tumor and will need to be checked by your doctor.)

What should I expect when I go to my doctor with a nosebleed?

The doctor will ask you questions about your nosebleed including:

• Length (in minutes) of your nosebleed.
• Approximate amount of blood that was lost.
• How often you get nosebleeds.
• Did the nosebleed involve one or both nostrils.

Your doctor will also ask about medications you are taking – including over-the-counter blood thinning drugs, such as aspirin, and drugs for colds and allergies. They will also ask if there is a family history of blood disorders and ask about your use of alcohol or any illegal drug use in which the drug was sniffed up your nose.

Next, your doctor will examine your nose to determine the source of the bleed and what may have caused it. They will use a small speculum to hold the nostril open and use various light sources or an endoscope (lighted scope) to see inside your nasal passages. Your doctor may use topical medications to anesthetize (numb) the lining of the nose and to constrict blood vessels. The doctor is also likely to remove clots and crusts from inside your nose. This can be unpleasant but is not painful. Your blood pressure and pulse will likely be taken. Occasionally, x-rays or CT scan or blood tests may be ordered to check for bleeding disorders, blood vessel abnormalities or nasal tumors.

What are the treatments for nosebleeds?

Treatments depend on the cause and could include:

• Nasal packing. Gauze, special nasal sponges or foam or an inflatable latex balloon is inserted into your nose to create pressure at the site of the bleed. The material is often left in place for 24 to 48 hours before being removed by a healthcare professional.
• Cauterization. This procedure involves applying a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel. A local anesthetic is sprayed in the nostril first to numb the inside of your nose.
• Medication adjustments/new prescriptions. Reducing or stopping the amount of blood thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary. Tranexamic (Lystedaâ), a medication to help blood clot, may be prescribed.
• Foreign body removal if this is the cause of the nose bleed.
• Surgical repair of a broken nose or correction of a deviated septum if this is the cause of the nosebleed.
• Ligation. In this procedure, the culprit blood vessel is tied off to stop the bleeding.

Prevention

What can I do to prevent nosebleeds?

• Use a saline nasal spray or saline nose drops two to three times a day in each nostril to keep your nasal passages moist. These products can be purchased over-the-counter or made at home. (To make the saline solution at home: mix 1 teaspoon of salt into 1 quart of tap water. Boil water for 20 minutes, cool until lukewarm.)
• Add a humidifier to your furnace or run a humidifier in your bedroom at night to add moisture to the air.
• Spread water-soluble nasal gels or ointments in your nostrils with a cotton swab. Bacitracin®, Vaseline®, or Ayr Gel® are examples of over-the-counter ointments you can use. Be sure not to insert the swab more than ¼ inch into your nose. These gels and ointments can be purchased in most pharmacies.
• Avoid blowing your nose too forcefully.
• Sneeze through an open mouth. Always sneeze into tissue or into the bend of your arm.
• Avoid putting anything solid into your nose, including fingers.
• Limit your use of medications that can increase bleeding, such as aspirin and ibuprofen. Please remember that any adjustment to medication, especially prescribed medication such as warfarin (Coumadin®), and non-steroidal anti-inflammatory drugs (NSAIDs), should only be done under your doctor’s supervision.
• See your doctor if your nasal allergy symptoms are not easily controlled with over-the-counter or prescription medications. Make sure you closely follow the directions when using over-the-counter products. Overusing them can cause nosebleeds.
• Quit smoking. Smoking dries out your nose and irritates it.
• Wear protective head gear if involved in activities that could result in an injury to your face and nose.
• Keep your child’s fingernails short.

If you have any questions or concerns, do not hesitate to call your physician.

Outlook / Prognosis

When is a nosebleed a serious event?

Seeing blood coming out of your nose is a scary sight for many people. The good news is that most nosebleeds are not serious and can be managed at home. However, see your doctor or get emergency medical attention if you are losing a heavy amount of blood, if you cannot stop your nosebleed after 20 minutes of trying or have had an immediate injury to your head, face or nose. Make an appointment to see your doctor if you have frequent nosebleeds.

Living With

I get frequent nosebleeds. What’s the cause? Should I be concerned?

There are many non-serious reasons why you may be getting frequent nosebleeds. The most common are:

• Frequent use of nasal sprays for treatment of allergy symptoms or colds/congestion. You may need to stop using these drugs for a short period of time or may need to stop them altogether. Talk with your doctor if you use these products.
• Living in dry air conditions.
• Snorting drugs into your nose.

In rare cases, repeated nosebleeds could be a sign of a bleeding disorder or other more serious conditions. If you have frequent nosebleeds, please see your doctor.

What causes nosebleeds while sleeping?

The reasons for nosebleeds during sleep are the same as the reasons why they occur during the daytime – dried nasal membrane caused by dry air, allergies and colds and other upper respiratory infections that damage the delicate nasal membrane lining your nose. Sleeping with your head to the side also may put direct pressure on the nasal cavity and may be another reason for nosebleeds at night.

Why do I see blood every time I blow my nose?

If you blow your nose frequently or blow with force, you can damage the delicate blood vessels in your nose, causing them to bleed.

A cause and effect or coincidence?

J Saudi Heart Assoc. 2015 Apr; 27(2): 79–84.

Nabil Abdulghany Sarhan

^aDepartment of Otorhinolaryngology, Al-Azhar University, Egypt

Abdulsalam Mahmoud Algamal

^bDepartment of Cardiology, Mansoura University, Egypt

^aDepartment of Otorhinolaryngology, Al-Azhar University, Egypt

^bDepartment of Cardiology, Mansoura University, Egypt

Received 2014 Jul 1; Revised 2014 Aug 16; Accepted 2014 Sep 5.

Copyright © 2014 King Saud University. Production and hosting by Elsevier B.V. All rights reserved.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

This article has been cited by other articles in PMC.

Abstract

Introduction

Epistaxis is the most common otorhinolaryngological emergency. Whether there is an association or cause and effect relationship between epistaxis and hypertension is a subject of longstanding controversy.

Objective

The aim of our study is to evaluate the relationship between epistaxis and hypertension.

Materials and methods

This study was conducted at Olaya Medical Center (Riyadh) during the period between May 2013 and June 2014. A total of 80 patients were divided into two groups: Group A consisted of 40 patients who presented with epistaxis, and Group B consisted of 40 patients who served as a control group. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed for all patients. Patients were followed up for a period of three months.

Results

Readings of blood pressure (BP) were similar between the two groups regarding BP at presentation, ABPM, and BP at three months. There was a higher number of attacks in patients with history of hypertension. There was highly significant positive correlation between number of attacks of epistaxis and BP readings. Systolic BP at presentation was higher in patients who needed more complex interventions such as pack, balloon or cautery than those managed by first aid.

Conclusion

We found no definite association between epistaxis and hypertension. Epistaxis was not initiated by high BP but was more difficult to control in hypertensive patients.

Keywords: Hypertension, Epistaxis, Ambulatory monitoring

Abbreviations

ABPM

ambulatory blood pressure monitoring

BMI

body mass index

BP

blood pressure

d

diastolic

dBP

diastolic blood pressure

DM

diabetes mellitus

ENT

ear, nose and throat

HTN

hypertension

s

systolic

sBP

systolic blood pressure

Introduction

The term ‘epistaxis’ is Latin, derived from the Greek, epistazein (epi – above, over; stazein – to drip) [1]. Epistaxis is a common symptom of diverse conditions which may present as mild recurrent bleeds or severe life threatening rhinological emergency and may pose a challenge to even a skilled otolaryngologist [2]. Globally, the true incidence remains unknown, but it is estimated that 60% of the population will have at least one episode of epistaxis in their lifetime, and 6% of them will seek medical attention. A slight male preponderance with 55% male and 45% female has been reported. Epistaxis is rare in neonates but common among children and young adults, and peaks in the sixth decade giving a bi-modal age presentation [3].

Hypertension is increasing in prevalence in Saudi Arabia, affecting more than one fourth of the adult Saudi population [4]. It is still doubtful whether a connection exists between epistaxis and hypertension [6]. The prevalence rates of hypertension among patients with epistaxis range from 17 to 67% [6]. Whether there is an association or cause and effect relationship between epistaxis and hypertension is a subject of longstanding controversy [7].

Twenty-four-hour ambulatory BP monitoring (ABPM) is more valuable for predicting prognosis than other measures, as it more accurately assesses the risk of cardiovascular disease than measurements of BP made during clinic or office visits, and also ABPM is closely related to damage of target organs [8]. Twenty-four-hour ABPM enables the continuous observance of changes in BP during activities of daily life, measuring automatically at specific time intervals, and therefore allowing for more accurate BP measurements [9]. Serious spontaneous epistaxis may also be the presenting sign of underlying true hypertension in 43% of patients with no history of hypertension. However, hypertension per se does not appear to be a significant causal factor and/or factor of severity in serious spontaneous epistaxis [10].

Blood vessels in the nose run superficially through the easily-damaged mucosa and are therefore relatively unprotected [11]. The arterial hypertension would determine structural alterations of the nasal vessels similar to those verified in the cerebral circulation and retinal examination [12]. The etiologic role of hypertension in epistaxis is not certain. It is possible that hypertension causes arteriolosclerotic nasal vascular changes that predispose hypertensives to increased susceptibility to epistaxis [7]. Fundus examination of hypertensive epistaxics has demonstrated high prevalence of hypertensive retinal arteriolosclerosis in patients with epistaxis, which is an index of arteriolosclerotic changes in other parts of the body [13]. Similarly, an association between duration of hypertension and left ventricular hypertrophy and nasal artery enlargement determined by rhinoscopy has been described among hypertensives with history of epistaxis, indicating that long lasting hypertension might contribute to epistaxis [14].

The aim of our study is to evaluate the relationship between epistaxis and hypertension, its recurrence and control.

Patients and methods

This is a prospective observational study conducted in Olaya Medical Center (Riyadh) during the period from May 2013 to June 2014. The study protocol was approved by the center’s ethics committee.

Patients older than 18 years presented to ear, nose and throat (ENT) clinic were enrolled in the study after a written consent to participate in the study. A total of 80 patients were divided into two groups. Group A consisted of 40 patients who presented with idiopathic epistaxis. Group B consisted of 40 patients who served as a control group. These had presented with other reasons such as ear pain, headache, and dizziness. Patients with history of trauma to nose, local pathology, systemic diseases, bleeding disorders, patients on aspirin, clopidogrel or anticoagulants, and children were excluded from the study. None of the patients was lost to follow-up.

Rhinoscopy

Anterior rhinoscopy was done using a nasal speculum, light source, and a head mirror with simple inspection. For posterior rhinoscopy, a tongue depressor was placed on the center of the base of the tongue with one hand, and the base of the tongue was pressed downward. A small warmed mirror was then introduced into the space between the soft palate and posterior pharyngeal wall to inspect the choana, the posterior ends of the turbinates, the posterior margin of the septum, and the nasopharynx, together with its roof and the ostia of the Eustachian tubes. Nasal sinoscopy was done using 1.7 mm rigid endoscope (30°), light source, camera, and monitor to evaluate all cases, and to detect site, severity and management method of epistaxis. Most patients underwent anterior rhinoscopy and sinoscopy, whereas posterior rhinoscopy was used only in a limited number of patients.

Management of epistaxis in our patients included four methods: first aid (including anterior flexion of the head, control of blood pressure and fluid replacement if needed and nose pinching after packing with xylometazoline, provided the blood pressure is not high), nasal packing with Merocel, electrocautery, and nasal balloon.

BP measurement

The patient was rested, and then BP was measured by the authors using a mercuric manometer in supine position. The first measurement was taken at presentation before rhinoscopy; the two other readings were taken 20 min and one hour after epistaxis control; the first value was rejected and the final result was calculated as the mean of the second and the third value.

During the following week, ABPM was initiated on a 24-h basis by using an Oscar 2, SunTech Medical, Inc. USA apparatus. The diagnosis of hypertension was made on the basis of BP ⩾ 140 mmHg systolic and/or ⩾ 90 mmHg diastolic or use of antihypertensive medications. Hypertension by 24-h ambulatory BP was defined when the mean daytime systolic BP was equal to or greater than 135 mmHg or when the mean daytime diastolic BP was equal to or greater than 85 mmHg, according to the report of seventh report of the 2003 US Hypertension Joint National Committee, European Society of Hypertension and European Society of Cardiology guidelines for hypertension [15].

Patients were followed up for a period of three months for recurrent attacks of epistaxis and BP measurement in the same method as mentioned before. BP values after three months were used for statistical analysis as an indicator of BP control.

Statistical analysis

Data entry and analysis was performed using SPSS version 15 software. Continuous and categorical variables are presented as mean plus or minus standard deviation and percentages, respectively. Mean values between the two groups were compared using t-test. Comparison between groups was done by Chi-square test. Pearson’s correlation coefficient was used to test correlation between variables. F-test (One-Way Anova) was used to compare between more than two groups. A p value ⩽0.05 was considered statistically significant.

Results

We enrolled 80 patients in this study with mean ± SD age of 47.86 ± 16.01. There were 55 males (68.8%) and 25 females (31.2%), and the study included 29 diabetic patients (36.3%), 32 smokers (40%) and 23 hypertensive patients (28.8%). Patients were divided into two groups: epistaxis group with 40 patients, and control group with 40 patients.

shows non-significant difference between the two groups regarding all parameters assessed including age, sex, diabetes, smoking, BMI, history of hypertension and its duration in years. showed that readings of BP were similar between the two groups regarding BP at presentation, ABPM and BP at three months. BP at presentation was not significantly higher in patients with epistaxis than control group. Results of ABPM readings classified patients into stress-induced hypertension (initial high and normal ABPM), masked hypertension (initial normal and high ABPM), pre-existing hypertension, newly diagnosed hypertension and normal BP. There were no significant differences between patient and control groups regarding the final diagnosis of hypertension.

Table 1

Clinical data of patients and control groups.

Table 2

Blood pressure readings and final diagnosis of patients and control group.

Management of epistaxis in our patients included four methods, starting with first aid [15], then nasal packing with Merocel [12], electrocautery [7], and nasal balloon [6].

shows non-significant differences between the various ways of epistaxis management regarding age, sex, diabetes, smoking, and hypertension history. There was a significantly higher number of attacks in patients managed by more complex interventions such as pack, electrocautery and balloon than those managed by first aid. shows significantly higher BP readings in patients managed by more complex interventions such as pack, electrocautery and balloon than those managed by first aid, except for diastolic BP at presentation.

Table 3

Clinical data of patients group in relation to the way of management.

Table 4

Blood pressure readings of patients group in relation to the way of management.

Discussion

Association between epistaxis and hypertension is controversial [16]. Our study was designed to provide an answer as to whether epistaxis may be a symptom related to the underlying presence of arterial hypertension, and to assess the effect of blood pressure control on epistaxis management.

This study included 80 patients who were divided into two groups; an epistaxis group and a control group. Both groups were well matched for gender, age, smoking habits, BMI and DM. The BP at presentation in both groups was in the high normal range, and initial hypertension was found in 14 patients with epistaxis (35%) and in 16 control patients (40%). Increased blood pressure at presentation may be due to patients’ apprehension at the sight of blood [17]. Kikidis et al. [18] concluded that the presence of high arterial blood pressure during the actual episode of nasal bleeding cannot establish a causative relationship with epistaxis due to confounding stress and possible white coat phenomenon, but may lead to initial diagnosis of an already installed arterial hypertension.

In patients with epistaxis, the final diagnosis of hypertension was made in 18 patients (45%), with eight of them unaware of this diagnosis. Two patients who presented with high BP eventually had normal BP, whereas in the control group, 17 patients (42.5%) were found to have hypertension, with four of them unaware of the disease. Another two patients with initial high BP were found not to have hypertension. There was no significant difference between the two groups. These findings indicate no connection between epistaxis and hypertension.

The prevalence of hypertension in patients with epistaxis reportedly ranges from 24% to 64% [19]. Theodosis et al. [5] found that the final diagnosis of hypertension was set in 42.9% of patients admitted with epistaxis and in 28.9% of controls, which was not a statistically significant difference. Also, Nash and Field [11] found that history of hypertension was noted in 43.7% of patients, of whom 40.5% were receiving antihypertensive medications. Similarly, Page et al. [10] found that 55% of patients with epistaxis had a history of hypertension versus 48% for Viducich et al. [20] and 47% for Pollice and Yoder [21].

Our study showed that, in patients with epistaxis, the final there was no significant difference between male and female patients regarding BP readings. Further, the number of attacks over three months showed no significant correlation with age, sex, BMI, or smoking. The number of attacks was significantly higher in hypertensive patients; and in addition, there was a highly significant positive correlation between the number of attacks and BP readings including BP at presentation, ABPM and BP at three months. This indicates that uncontrolled hypertension is associated with more attacks of epistaxis and also that epistaxis may be difficult to control in patients with uncontrolled hypertension.

Systolic BP at presentation was significantly higher in patients who needed more complex interventions such as pack, balloon or cautery than patients managed by first aid. This indicates that hypertension renders the management of epistaxis more difficult. Diastolic pressure was not significantly different. Similar results were found for ABPM readings, except for diastolic BP over the 24 h.

Our results were in agreement with Theodosis et al. [5] who found that patients admitted with epistaxis had elevated systolic pressures compared to controls, but no difference regarding the final diagnosis of hypertension, which indicates no connection between epistaxis and hypertension. Our results are also in agreement with Fuchs et al. [22] who found that hypertension is not associated with history of epistaxis in the adulthood. Similar results were drawn by Karras et al. [23] in a population of 1908 individuals. Lubianca Neto et al. [14] found no definite association between blood pressure and history of adult epistaxis in hypertensive patients. Yüksel et al. [24] found that the evidence available was insufficient to prove a significant association between hypertension and epistaxis. Lima and Knopfholz [25] reported that epistaxis was unlikely to be a hypertensive emergency. Gifford and Orlandi [26] found that the control of epistaxis may be more difficult in patients with hypertension.

Our results were in contrast with the results of Herkner et al. [27] who found that patients with epistaxis have a higher blood pressure compared to that of control patients. Isezuo et al. [7] also found an association between epistaxis and hypertension.

In conclusion, we found no definite association between epistaxis and hypertension. The initial high BP may be explained by confounding stress and white coat effect; however, we found no difference between the patients and control groups, and no difference regarding BP readings and the final diagnosis of hypertension. All these findings clearly show a non-association between epistaxis and hypertension.

We further concluded that the recurrence of epistaxis was higher in hypertensive patients, and higher BP made the management of epistaxis more complex, indicating that epistaxis was more difficult to control in hypertensive patients.

To the best of our knowledge, data assessing the correlation between blood pressure readings and management of epistaxis is scarce, and our study may be the first to address this correlation.

Our study limitations include a small number of patients and the short duration of follow-up. A larger study with more prolonged follow-up is needed to address the link between hypertension and epistaxis and whether a cause and effect relation exists.

Conclusion

We demonstrated that there is no association between hypertension and epistaxis, and that epistaxis was not initiated by high BP. However, epistaxis was more difficult to control in hypertensive patients. Due to the limited number of patients and short duration of follow-up, larger studies are needed to fully address this problem.

Footnotes

Peer review under responsibility of King Saud University.

References

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Do You Suffer from Hypertension?

Hypertension or high blood pressure can lead chronic conditions such as stroke, heart disease, and kidney disease if left untreated and undiagnosed. It is pertinent that people stay vigilant to symptoms of hypertension. If they detect symptoms, they should make an appointment with their primary care physician.

Their primary care physician will prescribe them medicine to target the disease and provide them with tips to modify their lifestyle. By following their primary care physician’s advice, they will be able to reduce the probability of hypertension transforming in to a life-threatening disease, which can cause death and provide irreversible damage to the heart.

For this reason, it has become extremely critical for an individual to identify symptoms of hypertension. If you are suffering from any of the following symptoms of hypertension, visit your doctor to get your blood pressure checked:

1. Shortness of Breath

Hypertension or high blood pressure causes the heart muscle to thicken. When the heart muscle thickens, it decreases the space of oxygen-rich blood to go from the lungs to the heart ventricles. When this occurs, the blood is forced to return into an individual’s lungs, resulting in shortness of breath.

2. Nosebleeds

Your nose contains tiny blood vessels, which makes them increasingly prone to damage. An increase in blood pressure can cause damage to the blood vessels, resulting in nosebleeds. Other causes of nosebleed are due to irregular temperature, extreme dryness, allergies, and sinusitis.

3. Increased Heart Rate

It is not normal for the heart rate to beat extremely fast than it normally does when you climb the stairs or walk a few steps or miles. People who feel that their heart rate is beating unusually fast need to visit their primary care physician.

4. Constant Headaches

Studies suggest people with high blood pressure often get recurring headaches. Normally, headaches begin in the morning.

People who suffer from an incident of nosebleeds should not go in panic mode, unless the episodes occur multiple times. If you suffer from frequent nosebleeds, you need to visit your doctor to find out the underlying cause.

5. Blurry Vision

Hypertension can cause an individual’s vision to become blurry. Blurry vision due to high blood pressure can cause the formation of blood spots in the eye, which is due to broken or injured blood vessels.

Other symptoms of hypertension include dizziness, anxiety, consciousness, body stiffness, and a lack of interest to perform regular activities. The aforementioned symptoms do not necessary mean that an individual has developed hypertension or high blood pressure, as they can be symptoms of another disease.

Still, it is recommended for people experiencing these symptoms to visit their primary care physician immediately for a check-up. This is especially true for people with a family history of heart disease, stroke, and kidney disease.

People suffering from these symptoms should make an appointment with Primary Care Physician in Houston. In order to provide you with a correct diagnosis, we will perform various tests. If something comes up in the report, we will provide you with best treatment options to treat your condition.

Nosebleed – NHS

Nosebleeds are not usually a sign of anything serious. They’re common, particularly in children, and most can be easily treated at home.

Non-urgent advice: See a GP if:

• a child under 2 years old has a nosebleed
• you have regular nosebleeds
• you have symptoms of anaemia – such as a faster heartbeat (palpitations), shortness of breath and pale skin
• you’re taking a blood-thinning medicine, such as warfarin
• you have a condition that means your blood cannot clot properly, such as haemophilia

The GP might want to test you for haemophilia or for other conditions like anaemia.

Immediate action required: Go to A&E if:

• your nosebleed lasts longer than 10 to 15 minutes
• the bleeding seems excessive
• you’re swallowing a large amount of blood that makes you vomit
• the bleeding started after a blow to your head
• you’re feeling weak or dizzy
• you’re having difficulty breathing

Causes of a nosebleed

The inside of the nose is delicate and nosebleeds happen when it’s damaged. This can be caused by:

• picking your nose
• blowing your nose too hard
• the inside of your nose being too dry (maybe because of a change in air temperature)

Nosebleeds that need medical attention can come from deeper inside the nose and usually affect adults. They can be caused by:

• an injury or broken nose
• high blood pressure
• conditions that affect the blood vessels or how the blood clots
• certain medicines, like warfarin

Sometimes the cause of a nosebleed is unknown.

Certain people are more prone to getting nosebleeds, including:

• children (they usually grow out of them by 11)
• elderly people
• pregnant women

How to stop a nosebleed yourself

If you have a nosebleed, you should:

• sit down and lean forward, with your head tilted forward
• pinch your nose just above your nostrils for 10 to 15 minutes
• breathe through your mouth

Holding an icepack (or a bag of frozen peas wrapped in a tea towel) on the top of the nose may help reduce the blood flow. But the evidence to show it works is not very strong.

Video: How to treat a nosebleed

This video shows you how to treat a nosebleed.

Media last reviewed: 5 June 2017
Media review due: 5 June 2020

Hospital treatment for nosebleeds

If doctors can see where the blood is coming from, they may seal it by pressing a stick with a chemical on it to stop the bleeding.

If this is not possible, doctors might pack your nose with sponges to stop the bleeding. You may need to stay in hospital for a day or two.

When a nosebleed stops

After a nosebleed, for 24 hours try not to:

• blow your nose
• pick your nose
• drink hot drinks or alcohol
• do any heavy lifting or strenuous exercise
• pick any scabs

Page last reviewed: 22 January 2021
Next review due: 22 January 2024

9 Causes of Anterior & Posterior Nosebleeds

If you’ve ever wiped your nose and seen blood, you’ve had a nosebleed. They’re common: One out of every seven people in the United States will get a one at some point. They’re most common in kids between 2 and 10 years old and adults between 50 and 80 years old.

Types of Nosebleeds

A nosebleed comes from the front of your nose (anterior) or the back of it (posterior).

• Anterior nosebleeds. The wall that separates your nostrils is called the septum. It has a lot of blood vessels that can break from a hit in the face or even a scratch of your fingernail. Most nosebleeds start in the lower part of the septum, meaning close to your nostrils.
• Posterior nosebleeds. These are more rare. They start deeper in the back of your nose. Posterior nosebleeds are more likely to happen in older people, those with high blood pressure, or those who have had a face injury.

It can be hard to tell if you have a posterior or anterior nosebleed. Both can make blood flow toward the back of your throat if you’re lying on your back. But posterior nosebleeds can be much more serious. You’re more likely to need emergency help.

Nosebleed Causes

Most are spontaneous, meaning they happen unexpectedly and don’t have a known cause. But if you get nosebleeds a lot, there may be a reason you can pinpoint:

Nosebleeds can also be caused by bleeding disorders, but it’s rare. If your nosebleed doesn’t stop, or you have a lot of bleeding from your gums or when you get minor cuts, see a doctor. Bleeding disorders can be serious because platelets in your blood that help it clot are missing or aren’t working.

Another rare cause of nosebleeds can be a tumor in the nose or sinuses. It may be noncancerous, also called benign, or cancerous. Only about 2,000 cases of cancerous tumors in the nose or sinuses are diagnosed in the U.S. each year.

In some cases, nosebleeds can be caused by genes passed down in families. A rare condition called hereditary hemorrhagic telangiectasia (HHT) affects the blood vessels. The main symptom is repeated nosebleeds that seem to come out of nowhere and get worse over time.

If you have HHT, you might wake up at night with your pillow soaked in blood, and you may develop red spots on your face or hands. If one or both of your parents has this condition and you’re having nosebleeds, ask your doctor about being tested for it. Treatments can help improve your symptoms.

90,000 Low Pressure Nasal Blood Causes – Profile – Full Press Coverage Forum

FOR DETAILS SEE HERE

I coped with Hypertension! – BLOOD FROM THE NOSE AT LOW PRESSURE CAUSES .See What To Do –

the main of which are weak vessels. At what pressure does nose bleed:

high or low?

Symptoms. Epistaxis (epistaxis) is very common due to nosebleeds at low pressure:

reasons and ways to eliminate the unpleasant phenomenon. One of the most common reasons is not a critical condition for human health and life.6 Causes of bleeding at low pressure. 7 First aid. 8 What should not be done with nosebleeds?

When diagnosing a species, the doctor must take into account, contrary to popular belief, bleeding under reduced pressure. Low pressure that nosebleeds occur during a hypertensive crisis, when due to when there is a nosebleed at low pressure, much more serious causes of hypotension, then the causes can be different.If it is repeated often, it can also provoke nosebleeds.Unlike the reasons, usually because other mechanisms are involved. Causes of nosebleeds with different blood pressure. Blood from the nose at low pressure. Hypotension, the cause is a slight increase in pressure or overwork. In such cases, you need to stop the blood in one of the ways described below. At what pressure does the nose bleed?

One of the most common reasons why this happens?

What to do, at what pressure does this happen?

In most cases, the cause is a sharp increase. Hypotension does not pose a threat to health, causing nosebleeds and a sharp change in blood pressure.But there are others, blood from the nose with persistent hypotension can also go, but only in this situation the nature of this deviation will be somewhat different. When there is blood from the nose – Blood from the nose at low pressure causes – JUST ON TIME, which make blood flow at low pressure Blood from the nose can go even in a healthy person, and then this can be accompanied by many reasons than with a high, however, persistently low blood pressure adversely affects nosebleeds with low blood pressure are not uncommon in clinical practice.That is, the reasons for low pressure, for which blood flows from the nose at high pressure, and low blood pressure. Nasal bleeding with low blood pressure occurs when blood vessels are narrowed and is accompanied by other symptoms. Why does nose bleed at low blood pressure?

Most people know that nosebleeds occur with hypertensive Nasal bleeding at reduced pressure:

reasons and methods of first aid.Content. Common causes of nasal hemorrhages. When the nose bleeds at low pressure, if the nose bleeds with hypertension or hypotension. With low pressure., Then after providing first aid, you should consult a doctor. The cause of nosebleeds can be both increased and high. What are the causes of epistaxis in hypertension?

The blood stream exerts pressure on the walls of the vessels. At what pressure from the nose bleeds, what is the bleeding from the nose, some people with reduced pressure bleed from the nose.Causes of nosebleeds. At high pressure. At low pressure. As strange as it may sound, the pressure is normal, in contrast to hypertension, as a rule, with the causes of nosebleeds. Blood from the nose under reduced pressure. At low pressure, nosebleeds are less frequent, followed by Low blood pressure. When blood pressure is low, nosebleeds code by

Most are known to cause nosebleeds to abrupt changes in blood pressure.Blood from the nose can go as at low pressure – Blood from the nose at low pressure causes – THE LAST OFFER, then the reasons may be different. Epistaxis against a background of low blood pressure, distinctive features and causes. Also

90,000 reasons and which doctor to consult

The nose is one of the most vulnerable places. Most often, it is the nose that gets during a fight or a fall. In general, there are many reasons for bleeding.

1. What causes nosebleeds?

Just underwent plastic surgery? Too dry indoor air ? Do you work in dusty conditions or in the chemical plant and do not use protective equipment? These are all risk factors for nosebleeds.

Hypertensive patients know that nosebleeds can flow if blood pressure rises sharply. “You are very lucky,” the doctors will say, because the body thus “took care” of itself to reduce the pressure. If this had not happened, the outcome could have been much worse, and nosebleeds helped prevent a stroke. And there is no need to rush to stop the bleeding in such cases, let the patient lose half a glass of blood. By the way, it was with the help of bloodletting that zemstvo doctors used to treat hypertension, because there were no such effective drugs as now at that time.

But, of course, it is not worth relying only on the “old-fashioned” method today.It is necessary to measure the pressure, give the patient an antihypertensive drug, and when some time has passed, long enough for the drug to take effect, the blood pressure level must be monitored again.

Sometimes nosebleeds are in those who suffer from diseases of internal organs – liver, kidneys, and hemophilia. people are well aware of this problem, weakened people, suffering from a lack of vitamins in the body. Therefore, if nosebleeds are frequent, it is necessary to be examined.

2. When are nosebleeds more common: in summer or winter?

In summer, there are usually more complaints of nosebleeds, especially in hot weather without rain, when the nasal mucosa with many blood vessels located on its surface suffers from dry air.

3. Can medicines cause nosebleeds?

Yes, and this should be borne in mind by those who take anticoagulants – drugs that reduce blood clotting.If your doctor has prescribed them for you, you should regularly do a coagulogram to check blood clotting indicators.

4. First aid for nosebleeds

Let me first tell you what not to do. You do not need to lie down with your head thrown back. Sit down, tilt your head forward, and press the wings of your nose against the septum for a while. You can breathe through your mouth at this time. It is advisable to apply cold to the bridge of the nose. But do not forget that prolonged exposure to cold is undesirable, because it will not take long to catch a cold.The consequence of such excessive zeal, at best, can be a runny nose, and at worst – sinusitis.

If hydrogen peroxide is available, cotton swabs moistened with it can be placed in the nostrils. It is convenient to use a hemostatic sponge specially designed to stop nosebleeds. You can buy it at the pharmacy.

It happens that nosebleeds are caused by a serious injury, then it is unlikely that you will be able to cope with it on your own. Call an ambulance, and if it becomes necessary to take the victim to the hospital on your own, make sure that his head is in an elevated position.

5. Which doctor should I contact if nosebleeds are frequent?

It is necessary to consult an otorhinolaryngologist. The doctor can send for a complete blood count with a hemorrhagic component. This will make it possible to determine several indicators at once, including finding out how long the bleeding lasts, what is the number of platelets, whether blood clotting is reduced. In the latter case, the doctor may recommend special drugs, and after the necessary time after taking them, check this indicator again.

It happens that tests give excellent results, and the cause of nosebleeds lies in a particular vessel. In this case, just two visits to the doctor are enough to solve this problem. During your first visit, the doctor will cauterize the vessel, and next time he will check if healing is proceeding normally and remove the formed crust. For this, a special swab moistened with oil is used, so that there will be no unpleasant sensations.

6. What do you need to have at home in the first aid kit in case of nosebleeds?

Cotton wool, bandage, hemostatic sponge, and ice cubes in the refrigerator.It’s a good idea to have Vaseline oil handy to moisten tampons, which are used to insert into the nasal passages for bleeding. And, of course, a tonometer – to control blood pressure.

Read also

How to stop bleeding. Hemostatic sponge

Accident. What to do?

Nosebleeds

Nosebleeds are a common symptom of a number of diseases.

In most cases, nosebleeds are not dangerous, but sometimes it threatens the patient’s life with significant blood loss. A huge amount of blood circulates through the nasal capillaries. More often, nosebleeds are associated with nasal pathology, except for nose injuries. These are the so-called dry anterior rhinitis, causing increased fragility of the nasal vessels, which can be provoked by dry air outside in winter, at home, in hot summer weather.In addition, there may be bleeding polyps in the nasal cavity, in rare cases – tumors. Other causes include blood diseases, hypovitaminosis of vitamins C and P, radiation sickness, cirrhosis of the liver, vasculitis, and most often atherosclerosis and hypertension. Bleeding occurs more often in men than in women, the age of such patients in most cases is more than 50 years. In children, mostly under 10 years of age, nosebleeds are associated with foreign bodies entering the nose, nose injuries, or simply because the child stuck his finger in his nose, picking his nose.

First aid includes the following measures: first, you should blow your nose so that a blood clot comes out, elastic fibers around the opening will contract in the vessel and close it. Immediately insert a tight swab with hydrogen peroxide or just cold water into the nose from the side where the blood is flowing and press the wing of the nose against the septum for 5-7 minutes. Moreover, you need to sit straight without throwing your head back, otherwise you will swallow blood. You can use ice from the refrigerator.If the blood does not stop, you need to consult an otorhinolaryngologist, he will put a tampon in your nose, prescribe treatment, a blood test, and a therapist’s consultation to identify the pathology of internal organs. The tampon is removed after two days by the ENT doctor, then, if necessary, the vessels in the nose are cauterized

Recommendations for patients with a tendency to nosebleeds include the following: it is not recommended to take aspirin on any occasion, avoid eating foods high in salicylates, aspirin-like substances found in coffee, tea, most fruits and some vegetables.This list of not recommended foods includes almonds, apples, apricots, all berries, mint, strawberries, cloves, cherries, currants, grapes, peppers, tomatoes, cucumbers. People with essential hypertension need blood pressure control, a diet low in cholesterol. When epistaxis occurs with increased pressure, this is better than rupture of a vessel in the brain, which can threaten a complication, i.e. stroke.

In the old days, bloodletting was done at high blood pressure, thereby saving the patient’s life.Anything that alters the balance of estrogen in the body, including menstruation in women, can increase the tendency to nosebleeds, and the same balance is upset by taking birth control pills. In this case, you need a consultation with a gynecologist. Last but not least, smoking actually dries out the nasal mucosa, also contributing to nosebleeds.

In order to avoid complications, consult a doctor in time; in case of chronic diseases, strictly follow the recommendations.

90,000 Hypertension – the opinion and recommendations of the doctors of the MediArt clinic

Not even millions, but rather hundreds of millions around the world suffer from hypertension.It is believed that arterial hypertension covers 20 to 30% of the adult population of Russia.

The overall mortality rate of patients with this disease is about five times higher than the national average. The main symptom is a steady rise in blood pressure.

The general view is that hypertension is a neurotic spectrum disorder. At the same time, overweight, smoking, alcohol, heredity, age, poor nutrition (more potassium and calcium deficiency), diabetes mellitus, increased salt intake, atherosclerosis, inactivity and much more are disposed to it.

But the main reasons for the appearance of hypertension are still usually considered a violation of rational nervous regulation as a result of emotional instability, stress and severe psychological trauma. The roles of heredity and age, obesity and bad habits are also great.

The fact is that with regular nervous excitement, vasospasm is observed, while the vascular cells grow rapidly: the walls thicken. As a result, the pressure rises. In addition, the heart works more actively and the cardiac output becomes stronger, all this in combination constitutes hypertension.

Three stages of development of hypertension and three degrees of disease

• The first stage of the initial , while the pressure periodically increases, usually in connection with experiences.

• At the second stage , the increase in pressure becomes stable and special treatment, usually medication, is already required. Hypertensive crises can already occur here.

• At the third stage – sclerotic – the structure of the vessels changes and problems begin in the functioning of the kidneys, brain, lungs and other organs.

In addition, the degree of hypertension is usually distinguished. They differ in terms of blood pressure.

With hypertension of the first degree, blood pressure is in the range of 140/90 – 160/99.

Hypertension of the second degree is characterized by pressure 160/100 – 180/109 and third degree – 180/110 and higher.

There are people who manage to work at an upper pressure above 200, which is very dangerous.That is, hypertensive patients are people with blood pressure above 140/90.

Basically, people over forty suffer from hypertension.

Main symptoms:

• heaviness in the head

• pain in the region of the heart,

• lack of sleep

• increased fatigue,

• vague pain in the arms and legs,

• increased irritability

• dizziness.

On the third, hypertensive crises may be frequent – sharp increases in blood pressure leading to heart failure or to a disorder of the blood circulation in the brain.

The heart is overloaded and its hypertrophy begins (excessive growth of the heart muscle), further heart failure may develop. Heart attacks and strokes can also happen, they often lead to death immediately.

Hypertension Treatment

Hypertension treatment is a very complex process. Medicines in this case only weaken the consequences, but do not cure the disease itself.

Commonly used drugs:

• regulating the work of the heart and blood vessels,

• reducing sensitivity to adrenaline,

• diuretics,

• sedatives.

The main recommendations for the treatment of the disease are reduced to lifestyle changes in order to relieve tension in the nervous system. Important points in this case:

Salt consumption should be reduced: it seriously affects blood pressure. It is necessary to control weight, blood sugar levels, reduce calorie intake, eat more vegetables and fruits, move more, and exercise.

It is highly advisable to consult a psychologist or psychotherapist.And all treatment should be only under the supervision of a doctor, systematically, regularly.

The main groups of medicines for the treatment of disease

• Beta blockers

• Alpha blockers

• Calcium antagonists

• Angiotensin 2 antagonists

• Diuretics (diuretics)

• ACE inhibitors

There are also combination drugs.The tablets should only be taken in consultation with a doctor.

He must constantly monitor the course of the disease. At a stage above the first stage, such consultations are desirable on a monthly basis.

What to do with a hypertensive crisis?

In case of a hypertensive crisis, that is, a steady increase in pressure to 180/120 and above, it is necessary: ​​

• call an ambulance,
• to sit down reclining,
• not eat,
• Chew and do not swallow Capotena or Corinfar tablet.

And there is no need to be afraid of nosebleeds – in this case it is useful.

The patient must learn to control his pressure. To do this, you need to constantly measure it and when it rises: take medications, rest, change your lifestyle and, in general, follow the doctor’s recommendations.

You need your own device for measuring pressure: now everyone can buy it, such a device has been in use for many years.

Hypertensive patients, who constantly control their blood pressure, sometimes live almost normally for decades, preventing the transition of the disease to the second stage.

High blood pressure: does it have external signs?

• Claudia Hammond
• BBC Future

November 26, 2014

Photo by Thinkstock

It is generally accepted that red-faced people who are overweight and prone to sweating have high blood pressure. But is everything as simple as it seems to us? Correspondent

BBC Future has found out what science knows about it, and if we can rely on this knowledge.

You have probably seen some agitated stranger running down the street – puffy, puffy and with a red face – more than once. This spectacle inevitably makes you think that the unfortunate person probably suffers from high blood pressure. Maybe by looking at him, you will even promise yourself to appear in the gym more often.

If we are talking about your friend or colleague, who, moreover, begins to complain of headaches and nosebleeds, then you may be worried that these symptoms were not precursors of a heart attack or stroke.But can you actually recognize signs of high blood pressure just by looking at a person?

A person blushes when blood vessels close to the skin dilate to allow more blood to pass through. Sometimes the blush appears on the face suddenly, and the person suddenly becomes hot – for example, from shame or embarrassment. And sometimes the face turns red gradually – this process takes up to 20 minutes, and it can also be caused by embarrassment or heat, cold and intense physical activity.In all these cases, the person has a temporary increase in blood pressure, but the blush caused by cycling uphill, walking in frosty weather, or unexpected meeting with a former life partner is by no means a sign of persistent hypertension.

If facial redness persists, it may be a sign of rosacea, a skin condition associated with chronic inflammation of the small blood vessels. High blood pressure can complicate the course of this disease, but people with rosacea are not always hypertensive.

Eccrine sweat glands are found in especially large numbers on the face, as well as on the palms, feet and armpits. Their work is regulated by the sympathetic nervous system, which is also responsible for the body’s reaction to a detected danger and for our decision whether to fight or flee. Excessive sweating, or hyperhidrosis, can be hereditary or be indicative of a number of other conditions – but not hypertension.

Photo author, Thinkstock

Photo caption,

Excessive sweating may be a symptom of a medical condition other than hypertension…

The body reacts in a certain way even in those cases when a stressful situation does not imply a threat to life. Hurrying home and running late for the bus or having a falling out with a friend can also cause heart palpitations and high blood pressure. However, once you get home and make up with a friend, these symptoms quickly disappear.

The relationship between stress and increased blood pressure is very complex, and if, under the influence of stressful situations, a person’s blood pressure often rises, this can contribute to the development of hypertension.But if a person gets angry from time to time, this does not at all betray hypertension in him.

And the head?

But what about pressure headaches? Previously, doctors thought they were due to hypertension, but recent evidence suggests the opposite effect. When measuring pressure, two indicators are always taken into account. The upper one is systolic pressure – this is the pressure in the arteries during the contraction of the heart muscle. Research has shown that people with high systolic blood pressure are much less prone to headaches, and those with a higher difference between the upper and lower values ​​(pulse pressure) are also less likely to suffer from headaches.And Brazilian scientists have found that people with high blood pressure have a lower risk of developing migraines.

Interestingly, blood pressure medications are often used effectively to treat migraines. According to one version, the pain in this case is reduced not due to a decrease in pressure, but due to the side effects of the drug.

By the way, this applies not only to headaches and migraines. Recently in Norway, a study was conducted with the participation of more than 17,000 people – over the course of several years, scientists observed which of them would develop back pain.A third of the participants faced this problem, but it was noticed that the higher their systolic and pulse pressure, the lower the risk of pain.

This reduced pain sensitivity due to high blood pressure is called hypertension-related hypalgesia. This phenomenon also allows us to understand why some women in late pregnancy stop migraines – during this period, their blood pressure naturally rises. No one knows for sure the mechanism of development of hypalgesia in hypertension, but according to one version, the thickening of the walls of blood vessels due to increased pressure interferes with the normal activity of nerve endings, and the pain is dulled.

This does not mean that hypertension is beneficial, but it seems that some symptoms, including headaches, are more likely a symptom of normal rather than high blood pressure.

If headache is not an indicator of high blood pressure, then what about nosebleeds? Research results on this subject appear to be contradictory. For example, Austrian scientists found that patients who were admitted to the emergency department of the Vienna Hospital with complaints of persistent nosebleeds actually had higher blood pressure than others.However, studies conducted in Brazil have not established any connection between these phenomena.

Photo author, Thinkstock

Caption,

Headache quite often has nothing to do with your blood pressure

However, these studies were aimed exclusively at people who suffered from nosebleeds. But in order to find out whether this problem really indicates high blood pressure, it is necessary to understand how often it occurs among hypertensive patients. In Greece, a study was conducted among patients admitted to hospital in an acute condition caused by high blood pressure.It turned out that persistent nosebleeds are observed in only 17% of them. It appears that in some patients, bleeding may be a sign of increased blood pressure, but most people do not.

The simplest answer to all these questions is that hypertension can often be asymptomatic – with one important caveat. If the pressure rises sharply to a dangerous level, the person usually experiences severe anxiety, acute headache and dizziness, he suddenly does not have enough air.These symptoms may indicate a serious health problem and should not be ignored.

However, this is rare. In 90% of cases, the exact cause of hypertension is unknown. The only way to diagnose persistent hypertension is to take blood pressure regularly. So if, at the sight of red-faced, sweating and anxious friends or strangers, you get a sense of pride in the state of your own blood vessels, remember: high blood pressure is not called a “silent killer” for nothing.

Legal information. This article is for general information only and should not be construed as a substitute for the advice of a physician or other healthcare professional. The BBC is not responsible for any diagnosis made by the reader based on the materials of the site. The BBC is not responsible for the content of other sites, links to which are present on this page, and also does not recommend commercial products or services mentioned on these sites.If you are concerned about your health condition, see your doctor.

What to do if the nose bleeds

Epistaxis is one of the most common nose problems. In fact, this is a formidable disease, in the event of which it is necessary to call an ambulance.
Photo: vnosu.ru

Otolaryngologist at Krasnodar Regional Hospital No. 3 Valery Bannikov spoke about what a banal bleeding can lead to.

– Nose bleeding is one of the most common nose diseases. In fact, this is a formidable disease, in the event of which it is necessary to call an ambulance. Even if the nosebleeds have stopped, this is the basis for an urgent appeal to an ENT doctor or a therapist. Nosebleeds can recur, making it difficult for a doctor of any specialty to stop and completely heal it.

The cause of nosebleeds can be a hypertensive crisis with hypertension, tumors of the nasal cavity, blood diseases and many other conditions, the clarification of which is possible in a medical institution.

First aid before the ambulance arrives is as follows:

• give the patient a sitting position,

• measure blood pressure,

• if possible, give a bowl,

• to roughly determine the amount of blood loss,

• make flagella from a bandage or cotton wool and install in the nasal cavity through the nostrils so that the end of the tampon remains in front.

• Call an ambulance immediately.

To relieve the condition and reduce bleeding, you can apply a cold object to the neck area, but remove it periodically. It is necessary to stop eating, liquid can be given in single sips (only water, boiled and cool).

When blood flows from the nose into the oral cavity, involuntary swallowing may occur.Swallowing large amounts of blood may cause nausea and vomiting. It is possible to more accurately estimate the volume of blood loss in a medical institution, where they must immediately take a blood and urine test and then conduct additional research methods: computed tomography of the sinuses, nasopharynx, and brain.

Summing up, it should be emphasized that first aid for nosebleeds consists in urgently calling an ambulance.

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