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

Delhi-NCR witnessed unexpected showers in the city this year in the month of April. Before the heatwave could get as severe as it usually is every season, there were a few days where the national capital witnessed refreshing showers—but as it turns out, these showers often increase the risk of diseases like malaria. Yes, unexpected showers may bring temporary relief from heat, but they also quietly reset the risk for diseases like malaria. The concern today is not just rainfall, but how changing climate patterns are shifting the timeline of disease transmission—often weeks before the monsoon fully arrives.

Ahead of World Malaria Day, Dr Suranjit Chatterjee, Senior Consultant-Internal Medicine, Indraprastha Apollo Hospital, Delhi, spoke about the effects of such unexpected rains ahead of the monsoon season.

Has the malaria pattern changed?

Malaria has long been seen as a monsoon-linked illness, but that pattern is changing. Intermittent rainfall, rising temperatures, and increased humidity are now creating ideal breeding conditions much earlier in the year. Even a short spell of rain can lead to water accumulation in urban areas—on terraces, construction sites, in clogged drains, and in poorly managed storage spaces. These become hidden breeding grounds for mosquitoes, accelerating their life cycle and increasing the risk of early transmission.

When should you get tested for malaria?

From a healthcare perspective, this shift is significant. The first fever after early showers is often overlooked or dismissed as a seasonal viral infection. However, malaria in its early stage can closely resemble common viral illnesses, presenting with symptoms such as fever, chills, headache, body ache, and fatigue. This overlap frequently delays diagnosis. Any fever that persists beyond 2–3 days, recurs, or does not respond to basic treatment should be tested promptly. Early detection remains critical to preventing complications.

What are the symptoms of malaria?

Early malaria can look like a common viral fever. The symptoms of the disease are:

1. Body aches
2. Fever
3. Chills
4. Weakness
5. Headaches

Malaria prevention matters

Waiting for the monsoon to begin preventive action is no longer effective. The response must start with the first signs of rain. Clearing drains, eliminating stagnant water, monitoring construction zones, and ensuring proper waste management are essential early steps. At the household level, covering water containers, maintaining clean terraces, and regular checks for water accumulation can significantly reduce risk. Some of the key precautions to take against malaria are the following:

1. Use a mosquito repellent before going outdoors
2. Wear long sleeves and light coloured clothes
3. Use bed nets
4. Avoid keeping the windows open, especially in the evening
5. Standing water are breeding ground for malaria; avoid water sit in coolers or pots for too long

A year-round public health priority

World Malaria Day serves as a reminder that malaria prevention is not seasonal—it is continuous. In an era of unpredictable weather patterns, cities and communities must adapt quickly. Acting only when cases begin to rise means reacting too late. The real shift lies in recognising that prevention must begin with the first unexpected shower, not the peak of the monsoon.

Urgent action is required to strengthen diagnostics and vaccines to address gaps in dengue treatment, public health experts said.

The experts, including scientists and policymakers, were speaking at a day-long dialogue hosted in New Delhi by the Drugs for Neglected Diseases initiative (DNDi) in collaboration with the Translational Health Science and Technology Institute (THSTI), the Ministry of Health and Family Welfare, and the WHO South-East Asia Region.

The convening assumes significance ahead of the monsoon season, which historically sees a rise in Aedes aegypti mosquito populations and dengue transmission across health systems in South and South-East Asia.

"The WHO South-East Asia Region alone accounts for more than half of the global dengue burden, with 1.3 billion people living at risk across 10 endemic countries," said Dr Catharina Boehme, Officer in charge, World Health Organization, South-East Asia Regional Office.

Dr. Boehme called the rising burden of dengue both an economic crisis and a social crisis. She noted that beyond health system costs, dengue often leads to "lost productivity, lost wages, lost futures".

"To change this trajectory, we must close the gap on diagnostics, on vaccines, on therapeutics, and on health system resilience," Dr. Boehme said.

Also read: New dengue vaccine over 80% effective, prevents severe disease for up to 5 years

India Advancing in Dengue Fight, Gaps Remain

India reported over 2.89 lakh dengue cases in 2023, though experts believe the actual burden could be significantly higher due to underreporting and surveillance gaps.

Taruna Madan Gupta, Scientist G and Head, Development Research Division, ICMR, called dengue an "unequivocally a national health priority for India."

Gupta noted that "India is advancing on multiple fronts—from strengthening public health systems to enabling public-private partnerships, including Phase III trials of an indigenous tetravalent dengue vaccine with over 10,000 participants, and regulatory progress on global vaccines".

However, the expert flagged a critical gap, which is "the absence of an effective therapeutic" for the mosquito-borne disease.

The experts noted that even though there are improvements in surveillance and scientific understanding, patients still lack access to specific treatment options.

“Addressing this gap requires sustained commitment from governments, funders, and partners," said Dr Sanjay Sarin, Continental Lead Asia and Director South Asia, DNDi.

What Is Dengue?

Dengue fever is a viral disease transmitted by Aedes mosquitoes, which are most active during the daytime. Dengue fever typically has minor or no symptoms, but it can occasionally result in severe sickness, hospitalization, and even death.

Common Symptoms include:

• Sudden onset of high-grade fever.
• Intense headache
• Severe muscle, joint, or bone pain.
• Skin Rash that often appears 2–5 days after the fever starts
• Nausea and Vomiting
• Fatigue

It estimates that:

• About 390 million dengue infections occur annually worldwide
• Nearly 100 million people develop symptoms each year

These vaccines are designed to protect against all four serotypes of the virus, with a focus on reducing severe disease and hospitalizations.

In today’s fast-paced, wellness-driven world, looking fit does not always translate to being reproductively healthy. Currently, even fit and active individuals are facing fertility challenges due to hidden hormonal and metabolic imbalances. Hence, it is necessary to focus on reproductive health. Dr. Meenu Handa, Director of Fertility & Head Academic of Reproductive Medicine, Motherhood Hospitals, Gurgaon, decoded the link and listed some of the common fertility issues that most people overlook.

Now, a large number of people are opting for various activities such as yoga, Zumba, Pilates, the gym, and kickboxing to stay fit. Those who are health-conscious are also maintaining an optimum weight with a proper diet. These habits, in turn, can help to ensure good fertility. Shockingly, many people who are perfectly fit and fine on the outside may also struggle with fertility problems. Yes, that is right! This is also a common occurrence nowadays. Couples are panicking as they seem to adhere to a well-balanced lifestyle but still fail to conceive. So, this can be referred to as “invisible fertility issues," where underlying hormonal or metabolic imbalances silently affect reproductive health.

Decoding invisible fertility issues

Dr Handa said that many men and women who exercise regularly may suffer from issues such as hormone imbalance, fluctuating insulin levels, poor thyroid function, and compromised reproductive organ health. Conditions like polycystic ovary syndrome (PCOS), thyroid disorders, insulin resistance, and even chronic stress can exist without obvious physical signs and can take a toll on fertility. The expert also shared some of the common hidden infertility issues.

Even couples who are physically fit today often deal with high mental stress due to demanding jobs and poor work-life balance. This ongoing stress can quietly disturb hormonal balance in the body. Increased cortisol levels may affect ovulation in women and sperm production in men and, over time, can impact egg and sperm quality—making natural conception more difficult. That is why managing stress is just as important as staying physically fit when planning a pregnancy.

Women may have issues like poor ovulation, compromised egg quality, or hormonal imbalance, even if their menses tend to be regular. In some cases, even subtle symptoms like fatigue, acne, hair fall, or mood swings may be overlooked but can signal deeper hormonal concerns. Men can struggle with low sperm count, which can affect their fertility. Even insufficient sleep, excessive exercise, or extreme dieting can increase the chances of hormonal imbalance and fertility issues. It is necessary to consult an expert and seek timely help. Pollution and lifestyle stress also contribute to the trend.

Couples should not just plan a pregnancy because they are fit and exercise daily. Pregnancy should not rely only on outward fitness as a sign of reproductive health. Regular health check-ups, including hormone tests and fertility assessments, can help identify hidden issues early.

Follow these tips

1. Couples should eat a well-balanced diet, exercise daily, stay stress-free by practicing yoga and meditation, and get enough rest.
2. It is also imperative to maintain blood pressure and blood sugar levels within the recommended range, include healthy fats and proteins in the diet, avoid overtraining, and manage stress through relaxation techniques like yoga or meditation, which can support hormonal balance.
3. If a couple is unable to conceive even after 6–12 months of trying (depending on age), a detailed fertility evaluation is recommended.
4. Seeking timely medical advice is equally important if conception is delayed.
5. Couples who find it challenging to conceive may be advised to use ARTs, such as in vitro fertilisation (IVF).

So, awareness, balanced lifestyle choices, and timely medical support can make a huge difference in improving fertility outcomes.