title: Is epistaxis associated with arterial hypertension? A systematic review of the literature.
abstract: Both epistaxis and hypertension are frequent problems in the adult population. The relationship between the level of arterial pressure and incidence of epistaxis in a patient with hypertension is a question that appears frequently in the clinical practice. A systematic review of the literature regarding the relation of arterial hypertension with epistaxis was performed through MEDLINE and EMBASE. All studies, whether examining the correlation of arterial pressure at presentation of a patient with nasal bleeding or the repercussion of episodes of epistaxis in hypertensive patients, were included in this review. Studies were evaluated independently by two reviewers according to a standard evaluation form. Overall, nine studies fulfilled our inclusion criteria. Five of them were single-group (patient) studies, while the remaining four included a control group. In eight studies, the patient group included patients with epistaxis, while one focused on hypertensive patients. Six out of nine studies agree that arterial pressure is higher at the time of epistaxis, as compared to the control group or to the general population. Seven out of nine studies conclude that there is cross-correlation between arterial pressure and the actual incident of epistaxis. The presence of high arterial blood pressure during the actual episode of nasal bleeding cannot establish a causative relationship with epistaxis, because of confounding stress and possible white coat phenomenon, but may lead to initial diagnosis of an already installed arterial hypertension.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, 114 Vas. Sophias Avenue, 11527, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Kikidis
authors.forename: K
authors.initials: K
authors.lastname: Tsioufis
authors.forename: V
authors.initials: V
authors.lastname: Papanikolaou
authors.forename: K
authors.initials: K
authors.lastname: Zerva
authors.forename: A
authors.initials: A
authors.lastname: Hantzakos
mesh_terms: D004844:Epistaxis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence
references.citation: Drugs. 1994;48 Suppl 1:11-5
references.pmid: 7533701
references.citation: Niger J Clin Pract. 2008 Dec;11(4):379-82
references.pmid: 19320416
references.citation: Postgrad Med J. 1977 May;53(619):260-1
references.pmid: 876933
references.citation: PLoS Med. 2009 Jul 21;6(7):e1000097
references.pmid: 19621072
references.citation: Am J Emerg Med. 2002 Mar;20(2):92-5
references.pmid: 11880870
references.citation: World Neurosurg. 2010 Mar;73(3):155-64; discussion e23
references.pmid: 20860953
references.citation: ORL J Otorhinolaryngol Relat Spec. 1986;48(5):297-303
references.pmid: 3785907
references.citation: Int J Cardiol. 2010 May 14;141(1):105-7
references.pmid: 19138805
references.citation: Laryngoscope. 1999 Jul;109(7 Pt 1):1111-5
references.pmid: 10401851
references.citation: Otolaryngol Head Neck Surg. 2005 May;132(5):707-12
references.pmid: 15886622
references.citation: Ann Emerg Med. 2000 Feb;35(2):126-30
references.pmid: 10650229
references.citation: Am J Rhinol Allergy. 2012 Jan-Feb;26(1):55-60
references.pmid: 22391084
references.citation: Ann R Coll Surg Engl. 1996 Sep;78(5):444-6
references.pmid: 8881728
references.citation: Curr Drug Targets Cardiovasc Haematol Disord. 2004 Mar;4(1):13-22
references.pmid: 15032649
references.citation: Mo Med. 2011 Jan-Feb;108(1):50-4
references.pmid: 21462612
references.citation: J Laryngol Otol. 1990 Apr;104(4):308-11
references.pmid: 2370452
references.citation: Cardiol Rev. 2010 Mar-Apr;18(2):102-7
references.pmid: 20160537
references.citation: Blood Coagul Fibrinolysis. 2007 Jan;18(1):41-3
references.pmid: 17179825
references.citation: Blood Press. 2003;12(3):145-8
references.pmid: 12875475
references.citation: Hypertension. 1996 Jan;27(1):144-7
references.pmid: 8591878
references.citation: Front Biosci (Landmark Ed). 2011 Jan 01;16:1733-45
references.pmid: 21196259
references.citation: Acta Otorrinolaringol Esp. 2011 May-Jun;62(3):194-8
references.pmid: 21277555
references.citation: NCHS Data Brief. 2009 Dec;(26):1-8
references.pmid: 20018136
references.citation: Hypertension. 2008 Sep;52(3):425-8
references.pmid: 18695139
references.citation: Blood Press. 2009;18(5):242-6
references.pmid: 19919394
references.citation: Lancet. 2007 Aug 18;370(9587):591-603
references.pmid: 17707755