Is epistaxis evidence of end-organ damage in patients with hypertension?

Objectives/Hypothesis: To study the association between history of mild to severe epistaxis with different stages of hypertension and with other evide nce of target organ damage in a sample of patients attending an outpatient hypertension clinic, controlling for potential confounding factors. Study D esign: A survey of adult patients with hypertension. Methods: A consecutive sample of 323 adults with hypertension was studied, The main outcome measu res were history of adult epistaxis, high blood pressure, duration of hyper tension, nasal abnormalities, and fundoscopic and electrocardiogram abnorma lities. Results: Ninety-four patients (29.1% of the whole sample) reported at least one episode of nosebleed after 18 years of age. Of these, 59 (62.8 %) needed medical assistance to control at least one of the episodes. The h istory of epistaxis was not associated with blood pressure classified accor ding to the World Health Organization/International Society of Hypertension paradigm or classified as severe or not severe, There was a trend of an as sociation between history of epistaxis and duration of hypertension. The hi story of severe epistaxis (epistaxis that needed medical assistance) was no t associated with blood pressure classified as severe or not severe and wit h duration of hypertension. More patients with left ventricular hypertrophy had a positive history of adult epistaxis. There was no association betwee n history of epistaxis or history of severe epistaxis and fundoscopic abnor malities. Among the abnormalities detected at rhinoscopy, only the presence of enlarged septal vessels was associated with history of epistaxis, The p resence of enlarged septal vessels was strongly and independently associate d with history of epistaxis in the logistic regression model. Duration of h ypertension and left ventricular hypertrophy showed a trend for an associat ion with the history of epistaxis in the adult life. Conclusions: A definit e association between blood pressure and history of adult epistaxis in hype rtensive patients was not found. The evidence for an association of duratio n of hypertension and left ventricular hypertrophy with epistaxis suggests that epistaxis might be a consequence of long-lasting hypertension. The ass ociation between the presence of enlarged vessels at rhinoscopy with histor y of epistaxis in hypertensive patients is a novel observation that needs t o be addressed in future observations.