It was a typical morning. My mother was getting ready; this was her usual routine: bustling around the house. When she suddenly stopped and shouted, blood was oozing from her nose. As kids, my siblings and I were terrified. We scrambled to help, but it wasn't until later that we learned the cause of that alarming moment: high blood pressure. That day was our first lesson in the silent yet powerful effects of hypertension. Nosebleeds, or epistaxis, are common, and nearly everyone experiences at least one in their lifetime.

While most are minor and often caused by dry air or irritation, some can signal underlying health concerns. One recurring question is whether high blood pressure causes nosebleeds or is merely coincidental.

Where Exactly Does a Nosebleed Occur?

The nose is covered by a rich plexus of small blood vessels, making it prone to bleeding. Most nosebleeds are anterior in origin, occurring at the front of the nose, and are relatively benign. They often occur because of irritants such as dry air, frequent nose-blowing, or trauma.

On the other hand, posterior nosebleeds are caused by a source that is located deeper within the nasal cavity. They are less common but more severe, as the blood tends to flow backward into the throat, making them more difficult to control. Common causes of posterior nosebleeds include trauma, medical conditions, or high blood pressure.

Connection Between Nosebleeds and High Blood Pressure

Hypertension is the condition whereby the pressure of blood against the arterial walls is consistently too high. Over time, this may damage the fine blood vessels in the nose, causing them to rupture more easily.

Significant studies have shown a strong relationship between hypertension and severe cases of nosebleeds necessitating urgent care. A certain study showed that patients diagnosed with high blood pressure had 2.7-fold increased chances of having nosebleeds that were not slight.

However, it should be noted that mild hypertension by itself does not cause nosebleeds. Nosebleeds are more likely to happen during a hypertensive crisis when the blood pressure suddenly rises to above 180/120. A hypertensive crisis can also have other symptoms such as a severe headache, shortness of breath, and anxiety. Therefore, it is considered a medical emergency.

Why Does Hypertension Increase the Risk?

Chronic hypertension makes the walls of blood vessels weaker and less elastic, which easily causes them to tear. In the nose, this is especially vulnerable because the blood vessels are close to the surface. Sudden surges in blood pressure, such as in a hypertensive crisis, can cause tears in these weakened vessels, resulting in nosebleeds.

While hypertension is a contributing cause, nosebleeds occur infrequently as the only manifestation of high blood pressure. This makes regular monitoring for blood pressure all the more crucial, as hypertension has the reputation of being the "silent killer" since people often do not present symptoms until the disease has run its course.

Other Causes of Nosebleeds

• Dry Air: Cold weather or house heating dries out membranes that line the nose, hence susceptible to cracking.
• Trauma: Blows in the nose, nose picking or excessive nose blowing can traumatize blood vessels.
• Intrinsic Disease: Liver disease and kidney disease and drug therapy that affect clotting such as blood thinners enhance the risk of nose bleeding.
• Foreign Bodies: Children especially tend to insert objects up their noses, which can be irritating and bleed.
• Allergies or Infections: Chronic nasal inflammation resulting from allergies or colds causes irritation to the nasal mucosa.

Managing Nosebleeds at Home

For most nosebleeds, you can manage them yourself at home:

1. Sit up and lean slightly forward to prevent swallowing blood.

2. Press your nostrils together for at least 10 minutes.

3. Use a cold compress on the bridge of your nose to constrict blood vessels.

4. If the bleeding continues, use a nasal decongestant spray.

Consult a doctor if the bleeding persists beyond 20 minutes, is heavy, or follows a head injury.

Preventing Nosebleeds

Preventive measures can decrease the incidence of nosebleeds:

• Use a humidifier to maintain moisture in the air.
• Apply saline sprays or gels to keep nasal passages hydrated.
• Avoid nasal trauma by being gentle when blowing your nose.

For patients with hypertension, managing blood pressure is the best way to minimize the risk of complications. A combination of lifestyle changes, such as maintaining a healthy diet, regular exercise, and prescribed medications, can help keep blood pressure in check.

When to Worry About Nosebleeds

Most nosebleeds are harmless, but they can sometimes be signs of an underlying health condition. In adults with high blood pressure, frequent or severe nosebleeds should never be ignored. A health provider should be consulted in order to rule out any serious conditions and ensure appropriate treatment.

Regular check-ups, a healthy lifestyle, and awareness about the relationship between nosebleeds and high blood pressure would go a long way to protect your health. Indeed, prevention is always better than cure.

Epistaxis and hypertension. Post Graduate Medical Journal. 1977

Low-dose naltrexone has received plenty of attention as a strong candidate for treating people with chronic fatigue after COVID-19. But a new randomised clinical trial has found no significant improvement in fatigue, pain or any other symptoms when compared to a placebo.

The study, posted on medRxiv, examined low-dose naltrexone (LDN) in adults with post-COVID fatigue syndrome. The findings challenge hopes that an existing repurposed drug could provide relief for people whose symptoms have not subsided months after infection.

The paper has not yet undergone peer review, which means its findings have not been independently evaluated in a formal manner.

Study Based On 160 Adults With Long COVID

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160 adults aged 19 to 69 from British Columbia and Ontario, Canada participated in the trial. Participants had developed symptoms that resembled myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after a SARS-CoV-2 infection.

Researchers randomly assigned participants either low-dose naltrexone or a placebo for 16 weeks. The naltrexone dose began at 1 milligram daily and increased to a maximum of 4.5 milligrams, depending on how participants tolerated the treatment.

The main outcome was fatigue severity, which was measured using the Fatigue Severity Scale. At the end of the study, the average fatigue score was 4.2 in the LDN group and 4.4 in the placebo group.

The difference between the groups was not statistically significant, meaning the trial proved that the drug did not improve fatigue.

Researchers also found no significant differences between the groups in pain, overall ME/CFS symptoms, daily step counts or any other health aspects related to quality of life.

These results suggest that LDN did not provide any measurable benefit for the participants. The study also found that LDN was generally well tolerated over the 16-week period.

However, adverse events classified as grade 3 or higher were reported in five participants in the LDN group, or 6.2%, compared with three participants in the placebo group or 3.8%.

Why Has Low-Dose Naltrexone Attracted Interest?

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Naltrexone is an established medicine used at standard doses to treat alcohol use disorder and opioid use disorder. At much lower doses, it has been tested for conditions involving chronic pain, inflammation and fatigue.

LDN’s effects on immune signalling and inflammatory conditions have sparked interest in its potential use for long COVID, a condition that can involve fatigue, cognitive difficulties, pain, breathlessness and symptoms affecting several biological functions.

Researchers Caution

The findings apply specifically to adults with post-COVID fatigue syndrome who met the study’s criteria for ME/CFS-like symptoms.

Long COVID refers to symptoms that occur after a SARS-CoV-2 infection and cannot be explained by another diagnosis. Symptoms vary widely and may include fatigue, cognitive difficulties, breathlessness, sleep disturbances and problems with everyday activities.

Some people improve over time, while others experience prolonged illness that affects their ability to lead routine lives.

The results do not mean that long COVID symptoms are untreatable. Instead, they highlight how difficult it can be to identify effective treatments for a condition with varied symptoms.

There are currently no FDA-approved medicines specifically for long COVID, and care often focuses on managing individual symptoms.

People taking or considering naltrexone should discuss its benefits and risks with a healthcare professional rather than starting or changing treatment on their own.

Low-dose aspirin could play a key role in lowering the risk of dementia significantly in some older adults, according to a new genetic analysis. However, the benefit does not come without a complication: major bleeding.

The study, led by researchers at Monash University in Australia, is based on data from more than 13,500 participants in the ASPREE trial, which investigated the effects of low-dose aspirin in older adults. The study was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Researchers found that the benefit was mostly seen among people with a specific genetic trait linked with platelet count.

70% Lower Dementia Risk Was Seen Among Older Adults

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Platelets are small blood components that help form clots and stop bleeding. Researchers have previously examined how aggregation of platelets might contribute to dementia, but the role of genetically influenced platelet counts still remains unclear.

The researchers examined genetic scores related to platelet count and compared dementia results among participants who were either assigned aspirin or placebo.

Among people in the highest 20% of platelet count genetic scores, dementia developed in 1% of those taking aspirin, compared with 3.3% of those receiving a placebo. This represented approximately a 70% lower risk.

Lead author Dr Peter Fransquet, a research fellow at Monash University's School of Public Health and Preventive Medicine, said, “Previous trials found aspirin didn't prevent dementia when everyone was considered together.”

“Our findings suggest there may be more to the story,” he said.

Risk Of Bleeding Increased

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The benefit was accompanied by a safety concern. Among participants in the same genetic subgroup, major bleeding occurred in 4.4% of those assigned to aspirin, compared to 2.1% of those given a placebo. That is a difference of 2.3 percentage points in both dementia cases and major bleeding events. In other words, the lower dementia rate cannot be considered in isolation from the increased bleeding risk.

Aspirin reduces the ability of platelets to form clots. This can be useful for certain people who need to take precaution against cardiovascular events, but it can also increase the risk of serious bleeding, including bleeding in the gastrointestinal tract or brain.

The study therefore does not prove that aspirin offers a favourable overall balance of benefits and harms for people with this genetic profile.

Could This Help Personalise Dementia Prevention?

The researchers found that the genetic signal was not linked to established genetic risk factors for Alzheimer's disease and dementia. Instead, it pointed towards platelet factor as a possible direction for further research.

“What's particularly interesting is that the signal wasn't linked to the established genetic risk factors for Alzheimer's disease and dementia,” Fransquet said. “Instead, it's pointing us towards platelet biology and gives us a new avenue to investigate.”

The findings could contribute to more personalised approaches to dementia prevention, in which treatments are tailored to characteristics that influence how individuals respond. But the results need to be replicated in other populations and tested in a clinical trial specifically designed for people with the identified genetic profile.

Fransquet said, “People shouldn’t start taking aspirin to prevent dementia on the basis of this study without consulting with their doctor, particularly given the increased risk of serious bleeding,” he said.

High blood pressure can be managed with medication and dietary changes. But recent research suggests that certain mental health habits can also help fight hypertension.

Mental health practices like mindfulness, optimism and gratitude may also support cardiovascular health, partly by helping people manage stress better and maintain healthier habits.

Hypertension affects nearly half of adults in the United States. While lifestyle changes like reducing salt intake, exercising regularly, maintaining a healthy weight and limiting alcohol remain crucial, the emerging study says that psychological wellbeing can also have a beneficial effect on blood pressure.

“Stress contributes to hypertension,” said Willie E. Lawrence Jr., a cardiologist and spokesperson for the American Heart Association. “It’s hard to get all the stress out of your life, but there are things that you can do to lower blood pressure, like mindfulness.”

According to the researchers, here are three mental health habits that may help:

Mindfulness

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Mindfulness refers to paying attention to thoughts, emotions and physical sensations in the present moment without judging them. It may help alleviate stress and improve behaviours that affect blood pressure like dietary choices and physical activity.

Eric Loucks, professor of epidemiology and director of the Mindfulness Center at Brown University, developed a mindfulness-based blood pressure reduction programme that teaches participants all about self-awareness, attention control and emotional regulation. The programme teaches people to apply these skills to everyday decisions like choosing healthier foods.

“There can be energy that comes up to act on those insights,” Loucks said. “So if we decide we want to eat more healthily, can we be there with that energy in the grocery store, selecting the food for the week?”

Optimism

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Optimism means expecting positive outcomes while recognising that challenges exist. Research has linked an optimistic outlook with better cardiovascular health, but evidence that it lowers blood pressure in people who already have hypertension is limited.

A study based on more than 100,000 active-duty US Army personnel without hypertension found that the most optimistic participants were less likely to develop high blood pressure during an average follow-up of three and a half years.

Julia Boehm, professor and chair of psychology at Chapman University said that practising optimism does not mean ignoring difficulties. Instead, people can identify realistic, achievable actions that support their health, such as choosing nutritious meals or becoming more physically active.

“This might mean something concrete like, ‘Am I going to choose to eat the salad or the french fries at lunch?’ and thinking optimistically that my choices in any given moment are going to translate into measurable effects in the long run,” Boehm said.

Gratitude

Gratitude involves acknowledging the people, experiences and acts one appreciates. Some research suggests it may affect cardiovascular responses to stress.

One study found that writing a gratitude letter changed how systolic blood pressure responded during a stress test. Systolic pressure, the upper number in a blood pressure reading, measures pressure when the heart contracts.

Mindfulness, optimism and gratitude should complement established hypertension treatment, not replace it. Medication, regular physical activity, a balanced diet and screening remain essential.

As Boehm cautioned, “You can’t ignore the doctor’s advice to either take your medications or engage in physical activity or eat fruits and vegetables. It’s just one piece of a larger strategy to bolster health.”