In Table 1, patients characteristics, use of anticoagulant (ACT) or antiplatelet (APT) therapy and mean values of systolic (SBP) and diastolic (DBP) blood pressure at arrival in the ED (t0) and 30 min after the otorhinolaryngology visit (t30) (with eventual hemostasis) are reported. From April 2014 to February 2015, 102 patients were enrolled into the study group (A) according to the predefined inclusion/exclusion criteria and to the protocol. Among all the patients, 60% of patients presented with active epistaxis, almost 40% with recent episode of nose bleeding occurred in the last 24 h. When required, patients underwent a hemostasis procedure during the otorhinolaryngology visit. The hemostasis was performed by bipolar cauterization of the nasal bleeding vessel under local anesthesia, or with nasal packing with resorbable nasal swab. Mean age was 67 years (range 15–93 years), and the male-female ratio was 2:1.

Group B was identified from May 2023 to August 2023. It consists in 126 patients enrolled according to the predefined inclusion/exclusion criteria and to the protocol. The following diagnoses were recorded: vertigo was the most common diagnosis, affecting 31 patients (24.60%), rhinitis/sinusitis was diagnosed in 9 patients (7.14%), pharyngotonsillitis/tonsillar abscess/laryngitis affected 27 patients (21.43%), an ENT district neoplasm was found in 3 patients (2.38%), otitis was diagnosed in 24 patients (19.05%), sudden hearing loss was identified in 4 patients (3.17%), other ear conditions (foreign body, cerumen) were found in 9 patients (7.14%), traumas (ear, larynx) were diagnosed in 2 patients (1.59%), laryngeal dyspnea/airways obstruction was identified in 1 patient (0.79%), foreign body (ear, nose, pharynx) was diagnosed in 2 patients (1.59%), facial palsy was found in 3 patients (2.38%), acute infections of salivary glands were diagnosed in 3 patients (2.38%), neck abscess was identified in 1 patient (0.79%), examination negative or other cases were recorded in 7 patients (5.56%).

In both groups a progressive reduction of BP values from t0 to t30 was observed (p = 0.001). Taking into account group A, in 73% of cases (75 patients) BP values > 140/90 mmHg were measured at t0, and this percentage decreased to 26% (27 patients) at t30. The same was observed in group B, where BP values > 140/90 mmHg were recorded in 75 patients (60%) at t0, while at t30 only 29 patients (23%) had a high BP. The mean BP decreased from 145/85 mmHg to 137/82 mmHg in group A, and from 138/83 mmHg to 133/82 mmHg in group B (Fig. 1, 2). No anti-hypertensive treatment was given to the patients during the evaluation. SBP was higher in the group of patients with epistaxis (group A) compared to the control group (group B) while there were no differences regarding DBP and the prevalence of hypertension was not different between the two groups. However, the age of the patients belonging to group A was higher than that of group B (Table 1). For this reason, logistic regression was performed (Tables 2 and 3). Epistaxis was positively associated with ACT and/or APT, while it was not associated with systolic or diastolic blood pressure values. Multivariate logistic regression analysis screened out that the main independent risk factors for epistaxis (p-value = 0,016) is the use of ACT and/or APT, while sex, age, SBP, DBP, and high BP didn’t show a statistically significant result (p-value > 0,05) (Table 2). Considering hypertension as the dependent variable, SBP variations becomes statistically significant (p-value < 0,001), meaning that when BP is higher, there is a more important reduction in SBP than DBP (Table 3)  ).