Table 9.

BIHS position: Management of hypertension in acute aortic syndrome (in particular type B).

Hypertensive emergency state	Acute aortic syndrome, mainly type B aortic dissection (type A dissection is a surgical emergency).
Speed of BP reduction and BP targets	1. Target SBP reduction to 120 mmHg and heart rate reduction to ≤60 bpm or the lowest level that allows as long as adequate vital organ perfusion is maintained.
	2. Ensure adequate analgesia (for example with morphine) and that agitation is controlled.
Medications	Labetalol or esmolol IV is preferred in the acute phase.
	IV nicardipine and or IV nitroprusside can be employed once heart rate is controlled. If ß blocker contraindicated, heart rate control can be achieved with non-dihydropyridine CCB. Oral medications subsequently added as tolerated.
	Long term management undertaken with oral antihypertensives to maintain a SBP target of ≤120 mmHg