by Stephen Janowsky

Created on: February 04, 2008

There is a common belief in many lay, but also in some medical environments, that people with high blood pressure (or arterial hypertension) are more prone to nose bleeding (a.k.a. epistaxis) than those with normal blood pressure. It is often thought that nose bleeding may actually reveal a preexisting ignored hypertension, or even that it may act as a "safety valve", helping to relieve the pressure in the blood system and, thus, protect hypertensive patients from other more dangerous events, such as cerebral hemorrhage (bleeding inside the brain).

Well, this really seems to make sense, doesn't it? If the pressure in the blood vessels is too high, it can be expected to produce the crack of a nose vessel and thus cause a nose bleed. However, one may wonder: "Why would the nose be the only victim? Why not bleeding at other sites from hypertension?" Well, has anyone heard of, say, gum or rectal or vaginal bleeding associated with high blood pressure? Very unlikely.

So, is there a true relation between nose bleeding and hypertension? Let's check the evidence. In the 1970s, Swedish researcher dr. Petruson and his colleagues found no correlation whatsoever between high blood pressure and epistaxis in almost four hundred 64-year-old men and concluded that when high blood pressure is found in a patient with nosebleeds it is probably a coincidental and not a causal factor. Ten years later, Petruson found that the blood pressure distribution of frequent nosebleeders did not differ from that of the general population used for comparison.

More recently, in 1999, Brazilian scientists Lubianca-Neto and coworkers studied 323 consecutive adult patients with hypertension, among which ninety-four (29%) had experienced at least one episode of nosebleed in their adulthood. The authors observed that: (1) the history of epistaxis was not associated with the blood pressure level; (2) the history of severe epistaxis (epistaxis that needed medical assistance) was not associated with the severity or the duration of hypertension; and (3) there was no association between the history of epistaxis or the history of severe epistaxis and hypertensive eye fundus (retinal) changes. A few years later, in 2003, the same Brazilian team confirmed the lack of a significant relation between hypertension and the history of nose bleeding in over 1100 subjects.

Finally, a recent Chilean research conducted in more than two thousand people came up with the same finding: the prevalence of epistaxis is similar (around 11%) in both normal and hypertensive individuals.

We may conclude, therefore, that the opinion that high blood pressure may cause nose bleeding is not based on evidence, but may be just another myth.

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