Hypertension should be assessed for and treated appropriately in all patients.[5]Fleischmann D, Afifi RO, Casanegra AI, et al. Imaging and surveillance of chronic aortic dissection: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging. 2022 Mar;15(3):e000075.
https://www.ahajournals.org/doi/full/10.1161/HCI.0000000000000075?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
http://www.ncbi.nlm.nih.gov/pubmed/35172599?tool=bestpractice.com
Other cardiovascular risk factors (e.g., dyslipidaemia and diabetes mellitus) should be intensively managed. Smokers should be encouraged to cease smoking, and offered counselling and/or smoking cessation therapy if they are willing. Drug use (specifically cocaine) is associated with aortic dissection, and should be strongly discouraged in patients with concomitant risk factors.[15]Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Nov 30;144(22):e368-454.
https://www.doi.org/10.1161/CIR.0000000000001029
http://www.ncbi.nlm.nih.gov/pubmed/34709879?tool=bestpractice.com
[20]Westover AN, Nakonezny PA. Aortic dissection in young adults who abuse amphetamines. Am Heart J. 2010 Aug;160(2):315-21.
http://www.ncbi.nlm.nih.gov/pubmed/20691838?tool=bestpractice.com
[28]Dean JH, Woznicki EM, O'Gara P, et al. Cocaine-related aortic dissection: lessons from the International Registry of Acute Aortic Dissection. Am J Med. 2014 Sep;127(9):878-85.
http://www.ncbi.nlm.nih.gov/pubmed/24835037?tool=bestpractice.com
[29]Daniel JC, Huynh TT, Zhou W, et al. Acute aortic dissection associated with use of cocaine. J Vasc Surg. 2007 Sep;46(3):427-33.
https://www.jvascsurg.org/article/S0741-5214(07)00969-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/17826227?tool=bestpractice.com
Patients with known Marfan or Ehlers-Danlos syndrome should be regularly monitored with echocardiography for aortic root aneurysm (predisposing to dissection).[6]Writing Committee Members, Isselbacher EM, Preventza O, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-393.
http://www.ncbi.nlm.nih.gov/pubmed/36334952?tool=bestpractice.com
Manage the patient’s blood pressure and heart rate very carefully. Aim for a target blood pressure of <120/80 mmHg, and a heart rate <60 beats per minute.[18]Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J. 2018 Mar 1;39(9):739-49d.
https://www.doi.org/10.1093/eurheartj/ehx319
http://www.ncbi.nlm.nih.gov/pubmed/29106452?tool=bestpractice.com
Beta blockade is first-line treatment.