Is the immediate blood pressure control using parenteral antihypertensive drug needed for patients with severe high blood pressure with epistaxis in the emergency department?

다국어 초록 (Multilingual Abstract)

Objective: This study aimed to assess whether the conventional treatments administered in the emergency department (ED) for hypertensive urgencies (observed or peroral [PO]-controlled) in severe high blood pressure (BP) patients with epistaxis increase the incidence of epistaxis recurrence and the mortality rate as compared to immediate BP control using intravenous (IV) antihypertensive medication Methods: A retrospective study over 7 years was conducted at the ED of a tertiary university hospital. Among adult patients with spontaneous epistaxis, subjects with severe high BP (systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg) were included in the study. Participants were divided into three groups determined by the methods used to control BP: non-controlled, PO-controlled, and IV-controlled groups. The incidence of epistaxis recurrence and mortality rate within 6 months were compared.
Results: Among the 380 patients enrolled, 238 were discharged from the ED without any pharmacological antihypertensive treatment (non-controlled group), 83 received PO antihypertensive medication (PO-controlled group), and 59 received IV antihypertensive medication (IV-controlled group). Of these, 29 (12.2%), nine (10.8%), and seven (11.9%) patients from the non-controlled, PO-controlled, and IV-controlled groups, respectively, experienced epistaxis recurrence within 24 hours, which was statistically not different among the three groups (P=0.948). The 6-month mortality rates were determined to be 0.8%, 2.4%, and 3.4% in the non-controlled, PO-controlled, and IV-controlled groups, respectively. The difference was also not significant among the groups (P=0.294).
Conclusion: The conventional treatments of hypertensive urgencies (observed or PO-controlled) in patients with severe high BP with epistaxis in the ED did not increase the incidence of epistaxis recurrence and short-term mortality rate when compared to immediate BP control using IV antihypertensive medication.

참고문헌 (Reference)

1 Chobanian AV, "The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report" 289 : 2560-2572, 2003

2 Isezuo SA, "Relationship between epistaxis and hypertension : a study of patients seen in the emergency units of two tertiary health institutions in Nigeria" 11 : 379-382, 2008

3 Sarhan NA, "Relationship between epistaxis and hypertension : a cause and effect or coincidence?" 27 : 79-84, 2015

4 Thomas L, "Managing hypertensive emergencies in the ED" 57 : 1137-1197, 2011

5 "Management of severe asymptomatic hypertension (hypertensive urgencies) in adults"

6 Karras DJ, "Lack of relationship between hypertension-associated symptoms and blood pressure in hypertensive ED patients" 23 : 106-110, 2005

7 Kim C, "Is epistaxis associated with high blood pressure and hypertension? Propensity score matching study" 38 : 1319-1321, 2020

8 Kikidis D, "Is epistaxis associated with arterial hypertension? A systematic review of the literature" 271 : 237-243, 2014

9 Grassi D, "Hypertensive urgencies in the emergency department: evaluating blood pressure response to rest and to antihypertensive drugs with different profiles" 10 : 662-667, 2008

10 Rodriguez MA, "Hypertensive crisis" 18 : 102-107, 2010

11 Michel J, "Guidelines of the French Society of Otorhinolaryngology (SFORL): epistaxis and high blood pressure" 134 : 33-35, 2017

12 Theodosis P, "Epistaxis of patients admitted in the emergency department is not indicative of underlying arterial hypertension" 47 : 260-263, 2009

13 Charles R, "Epistaxis and hypertension" 53 : 260-261, 1977

14 Sundstrom J, "Effects of blood pressure reduction in mild hypertension : a systematic review and meta-analysis" 162 : 184-191, 2015

15 Koroboki E, "Circadian variation of blood pressure and heart rate in normotensives, white-coat, masked, treated and untreated hypertensives" 53 : 432-438, 2012

16 Patel KK, "Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting" 176 : 981-988, 2016

17 Byun H, "Association of hypertension with the risk and severity of epistaxis" 147 : 1-7, 2020

18 Min HJ, "Association between hypertension and epistaxis : systematic review and metaanalysis" 157 : 921-927, 2017

19 Knopfholz J, "Association between epistaxis and hypertension : a one year follow-up after an index episode of nose bleeding in hypertensive patients" 134 : e107-e109, 2009

20 Muiesan ML, "An update on hypertensive emergencies and urgencies" 16 : 372-382, 2015

21 Fuchs FD, "Absence of association between hypertension and epistaxis : a populationbased study" 12 : 145-148, 2003

22 SPRINT Research Group, "A randomized trial of itensive versus standard bloodpressure control" 373 : 2103-2116, 2015