Hypertension in patients presenting with epistaxis at Kenyatta National Hospital.

Abstract

Background: A definite association between epistaxis and hypertension is not well established. Patients presenting with epistaxis, have been observed to have raised blood pressure (BP). The prevalence of hypertension (HTN) among patients with epistaxis is varied and spans from 17% to 67%. .Epistaxis may be the echelon sign of hypertension. Objective: To determine the prevalence of hypertension among patients presenting with epistaxis at Kenyatta National Hospital (KNH). Study Design and Site: This was a case-control study conducted at Kenyatta National Hospital. Study Population: Patients presenting with epistaxis, with an equal number of controls presenting with otological conditions. Methodology: The study involved 61 cases and an equal number of matched controls. On presentation, cases were stabilized, history taken followed by a general physical examination. Blood pressure measurements were then evaluated and recorded, using an automated blood pressure machine Omron model 907 (an average of three readings taken at least one minute apart). Appropriate treatment was commenced. Blood pressure measurements were repeated, one hour and 48 hours after the initial reading. Controls went through the same process except for the management of epistaxis. Results: The demographic attributes of the two groups were similar, with a male to female ratio of 2:1. The age range was 18 to 84 and 19 to 83 with a mean of 41.0±16.0 and 41.39±16.0 for cases and controls respectively. Baseline hypertension characteristics among the two groups were similar. There was a history of hypertension in 19.7% of cases and 14.8% controls, with a mean duration of 5-6 months among both groups. Blood pressure on presentation, among the cases, was higher compared to the controls, with a mean systolic blood pressure of 142.9±25.7 versus 132.6±18.7, P=0.01; mean diastolic pressure of 89.7±16.3 versus 82.7±11.7, P=0.007. Sustained hypertension was statistically higher among cases than controls (27.9% versus 13.1%, P=0.03). The odds ratio for having epistaxis and sustained hypertension was 2.12(CI: 0.99-4.55, 2χ =4.075, P=0.04). Conclusion: Sustained hypertension was 2.12 times more prevalent among patients with epistaxis compared to the controls. Recommendations: Further clinical trials, Population-based prospective cohort studies should be done, to delineate a causal relationship between hypertension and epistaxis.