Hypertension in patients presenting with epistaxis

Study objective: We sought to evaluate whether patients with epistaxis in t he emergency department have a higher arterial blood pressure compared with patients with other medical emergencies and to study the association of el evated blood pressure during epistaxis with sustained arterial hypertension . Methods: In a prospective, cross-sectional, prevalence study we compared ar terial blood pressure on admission in the ED in 213 consecutive patients tr eated for epistaxis with that of 213 sex- and age-matched control subjects. In 33 of those patients with elevated blood pressure during epistaxis, we evaluated the prevalence of sustained arterial hypertension. Main outcome m easures were arterial blood pressure during epistaxis and evidence of susta ined arterial hypertension, as determined by 24-hour ambulatory blood press ure measurement. Results: Patients with epistaxis had significantly higher blood pressure va lues compared with those of control patients (systolic blood pressure 161+/ -30 Versus 144+/-22 mm Hg, P<.001; diastolic blood pressure 84+/-19 versus 75+/-15 mm Hg, P<.001). Of 33 (30%) of 108 patients with elevated blood pre ssure during epistaxis who were further evaluated, 26 (79%) patients were c lassified as having sustained arterial hypertension. Nine (27%) patients wi th sustained arterial hypertension were unaware of a history of hypertensio n. Patients with sustained arterial hypertension had significantly more epi sodes of epistaxis compared with patients with elevated blood pressure duri ng epistaxis and no sustained arterial hypertension (mean 5 versus 1; P=.00 4). Conclusion: Patients with epistaxis have a higher blood pressure compared w ith that of control patients. Twenty-six (79%) of 33 patients with elevated blood pressure during epistaxis had sustained arterial hypertension. Nine (27%) of these patients were unaware of a history of hypertension. Continue d management of patients with epistaxis and high blood pressure should incl ude confirmation or exclusion of sustained arterial hypertension by 24-hour ambulatory blood pressure recording.