Nose and mouth bleeding with high blood pressure

Nosebleeds often arise from dry or irritated nasal tissue, nose picking, injury, or medicines that affect clotting. Blood in the mouth may come from the gums, nose draining backwards, an injured tooth, or the throat. Hypertension is often silent and does not explain every episode of bleeding, but a very high reading with symptoms can signal a medical emergency. Long-standing hypertension can affect organs such as the heart and kidneys. Conditions linked with high blood pressure include chronic kidney disease, obesity, and obstructive sleep apnoea; chest pressure or breathlessness may point to heart strain.

Sit upright, lean slightly forward, and pinch the soft part of the nose continuously while breathing through the mouth. Spit out blood rather than swallowing it. Do not tilt your head back or repeatedly check before the pressure has been held. If bleeding is from the mouth, use gentle pressure with clean gauze where safe. Rest quietly and take your prescribed blood-pressure medicine as directed; do not take an extra dose unless instructed. Record the blood-pressure reading and your symptoms for the clinician.

Seek emergency help for bleeding that is heavy or does not settle, or for a severe headache, weakness or numbness on one side, trouble speaking, new confusion, fainting, chest pain, severe breathlessness, or vision change. These symptoms can occur with stroke, transient ischaemic attack, angina, or a hypertensive emergency. Do not drive if you feel unwell.

Where is the blood most likely coming from? Is my reading high enough to need same-day review? Could any medicine be increasing bleeding? How should I monitor my blood pressure and manage another episode?