What should you know about epistaxis due to hypertension?

Nosebleed usually starts when small vessels in the nasal lining become irritated or break. Dry air, nose picking, forceful blowing, allergies, infection, injury, blood-thinning medicines, and nasal sprays can all contribute. High blood pressure may make bleeding harder to control or may be found when someone is checked, but a nosebleed alone does not diagnose hypertension. A clinician may check blood pressure, inspect the nose, and review medicines and other health conditions. Persistent high blood pressure can affect organs such as the heart, kidneys, and brain, so it deserves separate follow-up.

Sit upright, lean slightly forward, and breathe through your mouth. Pinch the soft part of the nose continuously while timing the hold; do not keep releasing it to check. Spit out blood rather than swallowing it. Avoid lying flat, tilting the head back, blowing the nose, heavy exertion, and hot drinks immediately afterwards. Take prescribed blood-pressure medicine as directed, but do not take extra doses to treat a nosebleed unless a clinician tells you to. Arrange a review for repeated episodes or difficult blood-pressure control.

Seek emergency care if bleeding is heavy, follows a significant injury, causes faintness or breathing difficulty, or does not settle after sustained pressure. Emergency help is also needed with very high blood pressure accompanied by chest pain, severe breathlessness, weakness, facial drooping, trouble speaking, confusion, or a sudden severe headache. These symptoms can signal a serious problem, including [Stroke](/conditions/stroke/) or [Heart Failure](/conditions/heart-failure/).

Could my medicines or nasal symptoms be contributing? How should I monitor my blood pressure? Do repeated nosebleeds need treatment of the nasal lining or a blood test?