A patient with hypertension is also having a condition as shown in the picture below. Anti-hypertensive agent of choice is ?
A. Sodium nitroprusside.
Ans:A. Sodium nitroprusside.
The condition shown in the picture above represents aortic dissection.
Antihypertensive therapy in acute aortic dissection
- Aortic dissection generally presents as a hypertensive emergency, and the prime consideration of medical management is strict blood pressure control.
- The target blood pressure should be a mean arterial pressure (MAP) of 60 to 75 mmHg, or the lowest blood pressure tolerated.
- Another factor is to reduce the shear-force dP/dt (force of ejection of blood from the left ventricle).
- Beta blockers are the first-line treatment for patients with acute and chronic aortic dissection. In acute dissection, rapidly acting, titratable parenteral agents (such as esmolol, propranolol, or labetalol) are preferred.
- Vasodilators such as sodium nitroprusside can be considered for patients with ongoing hypertension, but they should never be used alone, as they generally cause reflex tachycardia.
- Calcium channel blockers can be used in the treatment of aortic dissection, particularly a contraindication to the use of beta blockers exists. The calcium channel blockers typically used are verapamil and diltiazem, because of their combined vasodilator and negative inotropic effects.