How are hypertensive emergencies managed in adults with aortic dissection?

Updated: Feb 05, 2018
  • Author: Christy Hopkins, MD, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

For adults with aortic dissection, rapidly lower the SBP to below 120 mm Hg; the preferred agents are esmolol and labetalol. [21] Beta blockade should precede vasodilator administration, if needed for BP control or to prevent reflex tachycardia or inotropic effect; achieve SBP up to 120 mm Hg within 20 minutes. [21]

Maintain the SBP below 110 mm Hg, unless signs of end-organ hypoperfusion are present. The preferred treatment includes a combination of narcotic analgesics (morphine sulfate), beta blockers (labetalol, esmolol), and vasodilators (nicardipine, nitroprusside). CCBs (verapamil, diltiazem) are an alternative to beta blockers. [27]


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