What blood pressure goals are recommended for a patient with acute aortic dissection?

Bottom line:  Acute management includes blood pressure goal of < 120mm Hg systolic or lowest BP that maintains end organ perfusion.

Summary: Joint guidelines (ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM) on managing aortic dissection recommends goal of systolic BP < 120 mm Hg or lowest BP that maintains end organ perfusion during initial management.  For blood pressure control in ongoing medical management, guidelines recommend antihypertensive therapy to achieve a goal of less than 140/90 mm Hg (patients without diabetes) or less than 130/80 mm Hg (patients with diabetes or chronic renal disease) to reduce the risk of stroke, myocardial infarction, heart failure, and cardiovascular death.

Summary of treatment in Hypertensive Emergency article in DynaMed.  Briefly describes initial treatment in the setting of aortic dissection, including target systolic BP < 120 mm Hg within 5-10 minutes; usually requires beta blocker and vasodilator (vasodilator used without beta blocker increases risk of reflex tachycardia); options for beta blocker: esmolol or metoprolol; for vasodilator: nicardipine, nitroprusside, or fenoldopam.

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About Amy

Clinical Informationist at EUH Branch Library
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