Nose bleeds occur when fragile, poorly supported blood vessels running through the lining of the nose are damaged. It makes sense that having a high blood pressure could distend these delicate blood vessels and increase the chance of a spontaneous nose bleed.
Until recently, this assumption remained controversial, as studies which measured the blood pressure of people experiencing nosebleeds showed conflicting results. Some studies found that the number of people treated for nose bleeds who had hypertension ranged from 24% (lower than the prevalence of high blood pressure in the general population) while others found the risk was twice as great (up to 64%).
A new analysis of all available results has now confirmed the link between high blood pressure and nose bleeding. And the reason you need to take this seriously, and ensure your blood pressure is well controlled, is because otherwise you may be at increased risk of a stroke.
Nose bleeds and high blood pressure
To determine if spontaneous nosebleeds could be a sign of high blood pressure, ENT surgeons analysed 10 good quality studies that involving over 8,600 people. This confirmed that the risk of nose bleeding was 53% to 86% greater in people with hypertension than in those whose blood pressure was classed as normal. However, nose bleeding can be a sign of masked hypertension, in which blood pressure readings are normal during the day, and in the doctor’s office, but are significantly higher during the night.
One study reviewed the blood pressure charts of 60 people admitted to hospital with a nosebleed, and compared these to 60 similar patients without a nose bleed. They found that a third of those with nose bleeds (33.3%) had ‘masked’ hypertension, compared with one in eight (11.7%) of those without nose bleeds. There was no significant difference in daytime systolic blood pressure (upper reading) between the two groups, but night-time readings were significantly higher.
In one study, 43% of people admitted to hospital with a serious spontaneous nose bloods were found to have undiagnosed high blood pressure. There was no link between the severity of a nose blood and the severity of hypertension, however.
This was confirmed in another study that assessed the frequency of nosebleeds in people visiting an Emergency Department. People with hypertension stage 1 had an average of 7.6 nose bleeds per year, those with stage 2 hypertension had an average of 8 nosebleeds, while those with stage 3 hypertension had an average of 8.2 nose bleeds per year – no significant difference. Average blood pressure was 154/104 mmHg on routine readings (ie their high blood pressure was not well controlled) and 157/105 mmHg during a nose bleed episode.
It’s important to control blood pressure properly to prevent persistent nose bleeds. A persistent nosebleed (epistaxis) was significantly more frequent in people with hypertension than in those without (26% versus 8%) according to the records of people visiting an emergency department. Those with persistent nose bleeding had a significantly higher systolic blood pressure (average 181.3mmHg) compared with people presenting with other emergency conditions (156.6 mmHg, which is also raised partly due to the stress and anxiety involved).
If you experience persistent nose bleeds, your doctor may arrange for you to have ambulatory blood pressure monitoring with a cuff device that measures your blood pressure at regular intervals during the day and night. This will identify if you have a persistently raised blood pressure, or masked hypertension (raised during the night).
If you are already on antihypertensive medication, your treatment may need adjustment to achieve better blood pressure control.
Nosebleeds and stroke
It’s important to take recurrent nose bleeds seriously, as they can be a warning sign of an increased risk of a bleed within the brain (intracerebral haemorrhage) or stroke.
Doctors from Finland assessed the risk between nose bleeds, blood pressure and stroke in people aged from 36 to 90 years who experienced their first stroke. Within this group, they found the risk of stroke was increased almost seven-fold (by a factor of 6.95) for those with untreated hypertension, by almost four-fold (by a factor of 3.97) following recent strenuous physical exertion, and was almost three times more likely (by a factor of 2.92) for those with a history of nose bleed.
People with a history of nose bleed who had used nonsteroidal anti-inflammatory drugs, had an additional increased risk of stroke (increased by a factor of 2.75) while those who were on aspirin had a massively increased risk of stroke (14.7 fold more likely).
These are scary figures. If you have high blood pressure, are on aspirin, and are experiencing nose bleeds, please seek medical advice as soon as possible. This study suggests that nosebleeds are a warning sign of an increased risk of stroke in middle-aged and elderly people, both independently and when combined with the use of aspirin.
How to stop a nose bleed
If you have a nose bleed, don’t lean back so the blood trickles down your throat and is swallowed – this won’t help stop the bleeding and can make you feel sick.
Instead, do this:
- Sit forward slightly with your mouth open.
- Pinch the lower (soft) part of your nose for 15 minutes, while breathing through your mouth.
- Release the nostrils slowly, to check bleeding has stopped.
- Try to avoid touching or blowing your nose again for at least a few hours.
- If bleeding does not stop after 20 minutes, seek medical advice.
Nose bleeds that fail to stop are treated in hospital by packing the nose firmly with gauze. Sometimes a fragile blood vessel needs to be cauterised (sealed with heat) to prevent recurrent bleeding.
Sometimes, nose bleeding is due to dryness of the nose lining. This can be improved using a sterile saline spray. Recurrent nose bleeds can also result from infection or inflammation of the nose (eg allergic rhinitis). Rarely, recurrent nose bleeds indicate a blood clotting disorder or (even more rarely) a tumour of the nasal passages or sinuses.
Don’t ignore recurrent nose bleeds. See your doctor and have your blood pressure checked!
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