A 50 y/o M with a PMH of hypertension presents to the emergency department with epistaxis. A rhino rocket is placed. You note the patient’s blood pressure to be 196/100. He is A&Ox3 and denies any other symptoms. Should you treat this patient as hypertensive emergency and lower his BP?

Evidence suggests that there is no connection between hypertension and epistaxis. Furthermore epistaxis is not considered hypertensive emergency and patients should not be treated with antihypertensives in the absence of end organ injury.

Fuchs FD, Moreira LB, Pires CP, et al. Absence of association between hypertension and epistaxis: a population-based study. Blood Press. 2003;12(3):145-8.

Page C, Biet A, Liabeuf S, Strunski V, Fournier A. Serious spontaneous epistaxis and hypertension in hospitalized patients. Eur Arch Otorhinolaryngol. 2011 Dec;268(12):1749-53. doi: 10.1007/s00405-011-1659-y. Epub 2011 Jun 9.

Thanks to Trevor for the Pearl suggestion!