Primary prevention
Hypertension should be assessed for and treated appropriately in all patients.[24] Other cardiovascular risk factors (e.g., dyslipidemia and diabetes mellitus) should be intensively managed. Smokers should be encouraged to cease smoking, and offered counseling and/or smoking cessation therapy if they are willing. Drug use (specifically cocaine) is associated with aortic dissection, even without other risk factors, and should be strongly discouraged in patients with concomitant risk factors.[11][17][25][26]
Secondary prevention
Patients with known Marfan or Ehlers-Danlos syndrome should be regularly monitored with echocardiography for aortic root aneurysm (predisposing to dissection).[4]
Blood pressure control to less than 150 mmHg (preferably less than 120 mmHg) systolic and less than 90 mmHg is recommended. No data support exact goals, but shear forces are excessive when systolic blood pressure exceeds 150 mmHg. Heart rate should be maintained less than 80 bpm. Beta blockade is first-line treatment.
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