Which two medications are often recommended for blood pressure control during an aortic dissection?

In the management of an aortic dissection, controlling blood pressure is critical to reduce the shear stress on the aorta and prevent further dissection or rupture. Beta blockers are often the first-line treatment in this scenario due to their ability to effectively lower heart rate and blood pressure, which in turn helps to diminish the force exerted on the aortic wall during systole. This is particularly important since high heart rates can exacerbate the dissection.

Nitroprusside is commonly used in conjunction with beta blockers in cases where immediate blood pressure control is necessary. Although nitroprusside is a potent vasodilator that can rapidly lower blood pressure, its use is typically reserved for cases where beta blockers alone do not achieve desired levels of blood pressure control. The combination of a beta blocker, which reduces heart rate, and nitroprusside, which decreases systemic vascular resistance, allows for a comprehensive approach to managing high blood pressure during an aortic dissection.

This combination is recommended because it not only addresses the systemic effects of high blood pressure but also helps to manage potential tachycardia, thereby protecting the aorta from the damaging effects of elevated pressures and heart rates.