While nosebleeds can have multiple causes, their occurrence in people with high blood pressure may point to more serious underlying problems. Studies suggest those with hypertension are more likely to experience recurrent or severe nosebleeds requiring medical attention.
Published Apr 08, 2025 | 7:00 AM ⚊ Updated Apr 08, 2025 | 7:00 AM
A girl uses a tissue to stop a nosebleed. (iStock)
Synopsis: Nosebleeds are often seen as minor, but they can be a warning sign of serious health problems like high blood pressure. Doctors say chronic stress, poor sleep, and lack of exercise can increase the risk of hypertension.
A 40-year-old tech professional recently arrived at the emergency department of Apollo Hospitals in Hyderabad with a heavy nosebleed. He expected a quick fix – but instead received a diagnosis of dangerously high blood pressure: 210/110 mmHg.
It was his body’s final warning.
While nosebleeds – medically known as epistaxis – are often dismissed as harmless, they may signal more serious health issues, particularly in patients with hypertension (high blood pressure).
“Hypertension is often asymptomatic, but in some cases, it can present with severe complications such as massive epistaxis,” wrote Dr Sudhir Kumar, a neurologist at Apollo Hospitals, in a post on X.
The patient had no prior medical history. He did not smoke or drink, and had no history of substance use. But like many urban professionals, he experienced chronic stress, poor sleep, and led a largely sedentary lifestyle.
Nose bleed (epistaxis) as the presenting symptom of severe hypertension
➡️Hypertension is often asymptomatic, but in some cases, it can present with severe complications such as massive epistaxis.
➡️40-year-old man with no prior medical history presented with a life-threatening…— Dr Sudhir Kumar MD DM (@hyderabaddoctor) April 3, 2025
Nosebleeds can result from a variety of factors, including:
Often called the “silent killer,” hypertension typically develops without noticeable symptoms. It occurs when the force of blood against artery walls remains consistently high.
In healthy adults, normal blood pressure is around 120/80 mmHg. According to the American Heart Association, readings above 130/80 mmHg are classified as hypertension.
There are two main types of hypertension:
“Many people ignore hypertension medication or they do not even start the medication,” said Dr Achyuth Panuganti, Head and Neck Oncologist and ENT specialist in Secunderabad.
“However, it is important to treat it or else hypertension can lead to: heart attacks and strokes, heart failure, kidney damage, eye damage, vision loss, and even cognitive issues and dementia.”
Doctors say the connection between nosebleeds and hypertension is complex.
While nosebleeds can have multiple causes, their occurrence in people with high blood pressure may point to more serious underlying problems. Studies suggest those with hypertension are more likely to experience recurrent or severe nosebleeds requiring medical attention.
Dr Panuganti notes that emergency departments often see patients with nosebleeds linked to elevated blood pressure. While anxiety during a nosebleed can temporarily raise blood pressure, persistently high readings call for further investigation.
“Chronic high blood pressure can cause fragility of blood vessels, including those in the nose, making them more likely to rupture,” said Dr Jai Babu, Senior Consultant–Interventional Cardiologist and Heart Failure Specialist at Trust Well Hospitals in Bengaluru.
He added that sudden spikes in blood pressure – triggered by stress, exertion, or poor adherence to medication – can lead to nosebleeds, especially in individuals with pre-existing vascular damage.
Still, doctors stress that hypertension is not the direct cause of most nosebleeds.
“The prevalence of epistaxis in hypertensive patients ranges from 10 percent to 25 percent, according to various studies,” said Dr Kumar.
“Essential hypertension, where no secondary cause is identified, accounts for approximately 90 to 95 percent of all hypertension cases. It is strongly linked to genetic predisposition and modifiable risk factors, including stress, poor dietary habits, lack of physical activity and inadequate sleep.”
Dr Babu also pointed out that in hypertensive patients, bleeding often originates from deeper blood vessels.
“In hypertensive patients, nosebleeds tend to originate from the posterior nasal arteries, especially the sphenopalatine artery or branches of the posterior ethmoidal artery,” he explained.
“This type of bleeding is usually more severe, harder to control, and may require medical intervention like nasal packing or cauterisation.”
Doctors say nosebleeds in children are usually not linked to high blood pressure.
Common causes include:
In rare cases, they may result from bleeding disorders, abnormal blood vessels, or kidney-related conditions.
To manage a nosebleed, doctors recommend:
According to Dr Babu, the following groups are more likely to experience nosebleeds linked to hypertension:
(Edited by Dese Gowda)
