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Original Investigation
September 10, 2020

Association of Hypertension With the Risk and Severity of Epistaxis

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Hanyang University, Seoul, Republic of Korea
  • 2Biostatistical Consulting and Research Laboratory, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea
  • 3Department of Emergency Medicine, School of Medicine, Hanyang University, Seoul, Republic of Korea
  • 4Division of Cardiology, Department of Internal Medicine, School of Medicine, Hanyang University, Seoul, Republic of Korea
JAMA Otolaryngol Head Neck Surg. 2021;147(1):34-40. doi:10.1001/jamaoto.2020.2906
Key Points

Question  Is hypertension associated with the risk and severity of epistaxis?

Findings  This nationwide population cohort study of 71 498 individuals found that, compared with patients without hypertension, those with hypertension appeared to have an increased risk of epistaxis, had more emergency department visits, and required more posterior nasal packing procedures.

Meaning  This study suggests that hypertension is associated with an increased risk and severity of epistaxis.


Importance  The association between hypertension and epistaxis has long been a subject of debate.

Objectives  To evaluate the risk of epistaxis in patients with hypertension using a nationwide population cohort and to assess the association of hypertension with the methods of managing cases of epistaxis.

Design, Setting, and Participants  In this retrospective cohort study, a hypertension cohort and comparison cohort were built using the Korean National Health Insurance Service–National Sample Cohort that represents the entire population of the Republic of Korea from January 1, 2002, to December 31, 2015. The hypertension cohort comprised 35 749 patients with a record of 3 or more prescriptions of antihypertensive medication and a diagnosis of hypertension (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code I10). Patients with other diseases associated with epistaxis, such as sinonasal tumors, facial trauma, bleeding tendency, and coagulation disorder, as well as those taking anticoagulant medications, were excluded. A comparison cohort comprised 35 749 individuals without hypertension matched sociodemographically in a 1:1 ratio. Statistical analysis was performed from January 1, 2019, to March 31, 2020.

Main Outcomes and Measures  The incidence and recurrence of epistaxis were evaluated in both cohorts. The risk factors for epistaxis and management strategies were also assessed.

Results  Among the 35 749 patients in the hypertension cohort (20 579 men [57.6%]; median age, 52 years [interquartile range, 45-62 years]) the incidence rate (IR) of epistaxis was 32.97 per 10 000 persons (95% CI, 30.57-35.51 per 10 000 persons); among the 35 749 individuals in the comparison cohort (20 910 men [58.5%]; median age, 52 years [interquartile range, 45-62 years]), the IR of epistaxis was 22.76 per 10 000 persons (95% CI, 20.78-24.89 per 10 000 persons) (IR ratio, 1.45; 95% CI, 1.29-1.63; adjusted hazard ratio, 1.47; 95% CI, 1.30-1.66). The IR of recurrent epistaxis was 1.96 per 10 000 persons in the hypertension cohort and 1.59 per 10 000 persons in the nonhypertension cohort (IR ratio, 1.23; 95% CI, 0.77-2.00). Patients with hypertension who experienced epistaxis were more likely to use the emergency department (odds ratio, 2.69; 95% CI, 1.70-4.25; Cohen h effect size, 0.27; 95% CI, 0.16-0.39) and receive posterior nasal packing (odds ratio, 4.58; 95% CI, 1.03-20.38; Cohen h effect size, 0.15; 95% CI, 0.03-0.26) compared with the comparison cohort.

Conclusions and Relevance  This study suggests that patients with hypertension had an increased risk of epistaxis requiring hospital visits. In addition, epistaxis in patients with hypertension appeared to need more emergency department visits and require more posterior nasal packing procedures compared with patients without hypertension. Medical counseling about epistaxis is advisable for individuals with hypertension, and the presence of hypertension should be considered in managing nasal bleedings.

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