Introduction: Epistaxis is a common symptom in hypertensive patients. However, the relationship between hypertension and epistaxis is controversial and poorly understood. Objective: The present work was to study the histopathological changes underlying recurrent nasal bleedings in the patients with arterial hypertension (AH). Materials and methods: We have undertaken a prospective study based on the university clinic of Rostov-on-Don. Twenty-two hypertensive patients aged between 51 and 63 with recurrent epistaxis underwent surgical interventions due to severely deviated nasal septum hampering the search for the source of bleeding. Simultaneously nasal mucosae biopsies were taken in the bleeding point area. Tissue specimens were subjected to histological and ultrastructural investigations. Results: Histological and ultrastructural investigations of the biopsy samples revealed erythrocytic, hyaline, and fibrin thrombi in the vessels of the microcirculatory system, deendothelization, and destruction of the basement membrane alongside vascular subendothelium exposure. The above-mentioned changes in the nasal cavity mucosa lead to necrosis foci, which are the bleeding points. Conclusion: The cause of the nasal bleeding associated with AH is not a mechanical rupture of blood vessels but thrombosis and necrosis in the nasal mucosa. Clinical significance: Drug hemostatic treatment of hypertensive patients suffering from recurrent epistaxes is counterindicative due to possible serious thromboembolic complications (myocardial infarction, apoplexy, etc.). In case of a severely deviated septum hampering the search for the bleeding vessel, the treatment guidelines should include septoplasty.