Recommendations for Acute Medical Management of AAS

Referenced studies that support the recommendations are summarized in the Online Data Supplement.

COR	LOE	Recommendations
1	B-NR	1. In patients presenting to the hospital with AAS, prompt treatment with anti-impulse therapy with invasive monitoring of BP with an arterial line in an ICU setting is recommended as initial treatment to decrease aortic wall stress.1–5
1	C-LD	2. Patients with AAS should be treated to an SBP <120 mm Hg or to lowest BP that maintains adequate end-organ perfusion, as well as to a target heart rate of 60 to 80 bpm.3,6
1	B-NR	3. In patients with AAS, initial management should include intravenous beta blockers, except in patients with contraindications.2,5,7  In those with contraindications or intolerance to beta blockers, initial management with an intravenous non-dihydropyridine calcium channel blocker is reasonable for heart rate control.1,2,5
2a	B-NR
1	C-LD	4. In patients with AAS, initial management should include intravenous vasodilators if the BP is not well controlled after initiation of intravenous beta-blocker therapy.8
1	C-EO	5. Patients with AAS should be treated with pain control, as needed, to help with hemodynamic management.