Epistaxis as a marker of the unfavorable course of hypertension

Abstract

The aim of this research was to study changes in the nasal mucosa vessels in hypertensive patients suffering from recurrent epistaxis. Patients and methods. 78 hypertensive patients aged between 50 and 70, admitted due to epistaxis, were studied. Diabetic, coagulopathic patients and those taking anticoagulants were excluded from the research. All the patients were divided into 2 groups: group 1 (46 people) with a single epistaxis, group 2 (32 people) with a recurrent epistaxis. At the admission, all the patients showed elevated blood pressure, yet the differences between the patients of group 1 and group 2 were not significant. 14 patients of group 2 did not reveal any source of hemorrhage due to a severely deviated septum. These patients underwent septoplasty followed by mucoperichondrium biopsy. Histological study of the samples showed multiple erosions within the epithelial layer, as well as necrotic patches spreading to the deeper mucous coat layers. The microvasculature showed dystrophic changes in the endothelium, its focal desquamation with basal membrane exposure and thrombocytes and erythrocytes adhesion at such places, erythrocyte aggregation, plasma separation, erythrocyte and fibrinous thrombi formation. Thus, the cause of epistaxis is not high blood pressure, but those changes in the nasal mucosa vessels promoted by long-term arterial hypertension.