Aortic dissection medical therapy

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Medical Therapy
The prime consideration in the medical management of aortic dissection is strict blood pressure control. The target blood pressure should be a mean arterial pressure (MAP) of 60 to 75 mmHg. Another factor is to reduce the shear-force dP/dt (force of ejection of blood from the left ventricle).

To reduce the shear stress, a vasodilator such as sodium nitroprusside should be used with a beta blocker, such as esmolol, propranolol, or labetalol. The alpha-blocking properties of labetalol make it especially attractive in this situation.

Calcium channel blockers can be used in the treatment of aortic dissection, particularly if there is a contraindication to the use of beta blockers. The calcium channel blockers typically used are verapamil and diltiazem, because of their combined vasodilator and negative inotropic effects.

If the individual has refractory hypertension (persistent hypertension on the maximum doses of three different classes of antihypertensive agents), involvement of the renal arteries in the aortic dissection plane should be considered.

Acknowledgements
The content on this page was first contributed by: David Feller-Kopman, MD and C. Michael Gibson M.S., M.D.