Etiopathogenic features of severe epistaxis in histological samples from individuals with or without arterial hypertension

Gustavo Lara Rezende,Fabiana Pirani Carneiro,Leonel Alves Oliveira,Marcio Nakanishi,Selma Aparecida Souza Kückelhaus,Renata Oliveira Soares,Sônia Nair Baó,André Luiz Lopes Sampaio

doi:10.1038/s41598-022-05278-9

Gustavo Lara Rezende, Fabiana Pirani Carneiro + Show 6 more

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https://doi.org/10.1038/s41598-022-05278-9

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Journal: Scientific Reports	Publication Date: Jan 25, 2022
Citations: 1	License type: open-access

Affiliation: Universidade de Brasília, Hospital de Base

Abstract

There is a consensus that arterial hypertension (AH) is associated with stroke. Therefore, this study aimed to evaluate the histology of the microvasculature associated with the mucosa of the posterior nasal cavity to identify possible factors related to vascular weakening and rupture. Histological sections were obtained from hypertensive and normotensive individuals, regardless of epistaxis. Our results showed that the group with AH had: (a) smaller median diameter of the lumen of arteries and arterioles; (b) increased thickness of the intimal arteries and arterioles, slight inflammatory infiltrate, and rupture of internal elastic lamina; (c) greater thickness of the middle tunica in arterioles; (d) lower percentage of histological sections with non-injured intimal layers in capillaries, arterioles, and small arteries; (e) lower percentage of histological sections with intact media tunic and/or myocytes juxtaposed in arteries and arterioles; (f) no difference between the diameters of small arteries or arterioles. The intima was thicker in individuals with severe epistaxis than in the normotensive group, but it did not differ from the AH group. Thus, hypertension may cause structural lesions in the vascular layers, and in the absence of tissue repair and the persistence of AH, these lesions may favour vascular rupture, especially during hypertensive peaks.

Highlights

There is a consensus that arterial hypertension (AH) is associated with stroke
It is believed that the origin of severe epistaxis is idiopathic in more than 80% of cases[3], but some studies have suggested that it is associated with diabetes, progressive vascular obstruction, and systemic arterial hypertension (AH)[4,5,6,7]
When we evaluated the specimens from the six patients who underwent surgery for severe epistaxis and compared them to the normotensive (n = 8) and hypertensive (n = 10) groups, we observed that the median width of the intima was greater in the hypertensive group (25.0 μm) than in the normotensive group (6.5 μm), but it did not differ from the epistaxis patients (45.0 μm) (Fig. 2A); the median width of the media layer did not differ among the three groups (Kruskal–Wallis; p > 0.05) (Fig. 2C)

Summary

Introduction

There is a consensus that arterial hypertension (AH) is associated with stroke. this study aimed to evaluate the histology of the microvasculature associated with the mucosa of the posterior nasal cavity to identify possible factors related to vascular weakening and rupture. In AH, structural changes are initially observed in the microvasculature and in vessels of greater calibre to adapt to the increased blood pressure, prolonged alterations may lead to vessel weakening and rupture[9,10,11,12] These changes can result in the formation of the atheroma plaque (lipid deposit) in the tunica intima of medium- and large-calibre arteries, as well as arteriolosclerosis, caused by the thickening and hardening of the vascular wall of small arteries and arterioles. In both pathological processes, vascular weakening may evolve into the rupture of the compromised vessel, as observed in organs such as the heart, brain, kidneys, and limb extremities of individuals with A H5,13. This study sought to evaluate the structure of the posterior nasal

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