Relationship between epistaxis and hypertension: A study of patients seen in the emergency units of two tertiary health institutions in Nigeria

Background: Both epistaxis and hypertension are common in the general population. Objective:This study aimed at determining the prevalence of hypertension among epistaxics, and the relationship between epistaxis and hypertension. Methods: Retrospective analysis of 62 adults comprising 31 each of males and females with a mean age of 41.4 ± 16.6 years (range: 18-90 years) that presented in the emergency units of two tertiary health institutions seen over 11 years was done. Main outcome measure was the prevalence of hypertension amongst epistaxics. Seventy-six age and sex-matched patients with bleeding from sites other than the nostrils with no record of epistaxis were selected by simple random sampling as controls. Results: Peak prevalence of epistaxis occurred during the months of January and March. Compared to the controls, the epistaxics had significantly higher blood pressures: (146.1 ± 40.7 mmHg versus 123.2 ± 16.3 mmHg systolic, P =0.001), and (91.3 ± 24.8 mmHg versus 78.2 ± 12.8 mmHg diastolic, P=0.001), and higher proportions of patients with previous history of hypertension (32.3% versus 7.9%; p<0.001) and family history of hypertension (12.9% versus 2.6%; p<0.02)..The proportion of subjects with blood pressure elevation at presentation that remained sustained was significantly higher among the epistaxics than the nonepistaxics (87.5% versus 47.6%, X2=8.1, P=0.005). The epistaxics had significantly higher prevalence of hypertension than the non-epistaxics (45.2% versus 13.2%, X2=17.5, p=0.001). Univariate analysis demonstrated association between epistaxis and hypertension (OR=5.4, 95% CI=2.4-12.5, P=0.001), and between epistaxis and age (OR=0.9, 95% CI=1.3-12.5, P=0.02). On multivariate analysis using logistic regression the association between epistaxis and hypertension persisted, after adjusting for age, sex, season and causes of epistaxis(OR=5.6, 95% CI=1.7-15.6, P=0.01). Conclusions: Our findings support an association between epistaxis and hypertension in the study population.