What is the preferred pharmacological management for hypertensive emergency due to an aortic dissection?

{{c1::β-blocker (preferably esmolol) slowly until pulse 60-80bpm}}
{{c1::± IV infusion of sodium nitroprusside or glyceryl trinitrate::if refractory}}

<span style="font-family: Arial; font-size: 16px;">What is the preferred pharmacological management for hypertensive emergency due to an aortic dissection?</span><br style="max-width: 100%; font-family: Arial; font-size: 16px;"><br style="max-width: 100%; font-family: Arial; font-size: 16px;"><span style="font-family: Arial; font-size: 16px;">{{c1::β-blocker (preferably esmolol) slowly until pulse 60-80bpm}}</span><br style="max-width: 100%; font-family: Arial; font-size: 16px;"><span style="font-family: Arial; font-size: 16px;">{{c1::± IV infusion of sodium nitroprusside or glyceryl trinitrate::if refractory}}</span>

Use an intravenous infusion of a beta blocker to slowly reduce the heart rate to below 60 beats per minute, followed by an intravenous infusion of sodium nitroprusside or glyceryl trinitrate, titrating the dose to achieve a systolic BP of around 100 mmHg. It is important to give a beta blocker before giving a vasodilator, as tachycardia can occur if the vasodilator is given first.

Sodium nitroprusside or GTN infusion should be given with ICU level care and intra-arterial BP monitoring

<span style="font-family: Arial; font-size: 16px;">Use an intravenous infusion of a beta blocker to slowly reduce the heart rate to below 60 beats per minute, followed by an intravenous infusion of sodium nitroprusside or glyceryl trinitrate, titrating the dose to achieve a systolic BP of around 100&nbsp;mmHg. It is important to give a beta blocker before giving a vasodilator, as tachycardia can occur if the vasodilator is given first.</span><br style="max-width: 100%; font-family: Arial; font-size: 16px;"><br style="max-width: 100%; font-family: Arial; font-size: 16px;"><span style="font-family: Arial; font-size: 16px;">Sodium nitroprusside or GTN infusion should be given with ICU level care and intra-arterial BP monitoring</span><br>

<img src="54fcafa50b411134b06d7a0ede60f70d.webp"><br><img src="85f705e5122a8e16d6eada857ed0fd18.webp"><br><img src="601d0fb7271a73d22c74107a68e2c4b2.webp">

eTG - Urgent control of elevated blood pressure https://tgldcdp.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Cardiovascular&topicfile=c_CVG_Urgent-control-of-elevated-blood-pressuretopic_1&guidelinename=auto&sectionId=c_CVG_Urgent-control-of-elevated-blood-pressuretopic_1#c_CVG_Urgent-control-of-elevated-blood-pressuretopic_1 Published June 2023, Accessed 19 October 2024

FRCEM AFTBAFFF, FFSEM MCMMbcF, FACEM ACMMc. Marshall & Ruedy’s On Call: Principles & Protocols. 3rd edition. Elsevier; 2016. 648 Chapter 16: Chest Pain p. 117

Emergency Care Institute Aortic Dissection https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection

<span style="font-family: Arial; font-size: 18px;">eTG - Urgent control of elevated blood pressure&nbsp;</span><a href="https://tgldcdp.tg.org.au/viewTopic?etgAccess=true&amp;guidelinePage=Cardiovascular&amp;topicfile=c_CVG_Urgent-control-of-elevated-blood-pressuretopic_1&amp;guidelinename=auto%C2%A7ionId=c_CVG_Urgent-control-of-elevated-blood-pressuretopic_1#c_CVG_Urgent-control-of-elevated-blood-pressuretopic_1" style="max-width: 100%; font-family: Arial; font-size: 18px;">https://tgldcdp.tg.org.au/viewTopic?etgAccess=true&amp;guidelinePage=Cardiovascular&amp;topicfile=c_CVG_Urgent-control-of-elevated-blood-pressuretopic_1&amp;guidelinename=auto&amp;sectionId=c_CVG_Urgent-control-of-elevated-blood-pressuretopic_1#c_CVG_Urgent-control-of-elevated-blood-pressuretopic_1</a><span style="font-family: Arial; font-size: 18px;">&nbsp;Published June 2023, Accessed 19 October 2024</span><br style="max-width: 100%; font-family: Arial; font-size: 18px;"><br style="max-width: 100%; font-family: Arial; font-size: 18px;"><span style="font-family: Arial; font-size: 18px;">FRCEM AFTBAFFF, FFSEM MCMMbcF, FACEM ACMMc. Marshall &amp; Ruedy’s On Call: Principles &amp; Protocols. 3rd edition. Elsevier; 2016. 648 Chapter 16: Chest Pain p. 117</span><br style="max-width: 100%; font-family: Arial; font-size: 18px;"><br style="max-width: 100%; font-family: Arial; font-size: 18px;"><span style="font-family: Arial; font-size: 18px;">Emergency Care Institute Aortic Dissection&nbsp;</span><a href="https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection" style="max-width: 100%; font-family: Arial; font-size: 18px;">https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection</a>