Therapeutic target
Prevention of rupture (“rupture”).
Therapy recommendations
- Acute uncomplicated type B aortic dissection:
- Acute therapy ward (monitoring hemodynamics and urinary output).
- Analgesia (administration of analgesics).
- Lowering systolic blood pressure to less than 120 mmHg by intravenous administration of beta-blockers (esmolol, metoprolol) and vasodilators (labetolol, nitroprusside)Note: To prevent reflex tachycardia by administration of peripheral vasodilators, beta-blockade should precede.
- Drug therapy for arterial hypertension (high blood pressure) is essential in the presence of an aneurysm (see Hypertension (high blood pressure)/Medicinal therapy); furthermore, treatment of cardiovascular risk factors (statins/cholesterol-lowering agents are indicated in cardiovascular primary or secondary prevention).
- In Marfan syndrome, beta-blockers should be used to reduce the progression of aortic dilatation (widening of the aorta). Losartan is thought to counteract aortic aneurysm formation (beneficial effect on TGF-beta/connective tissue metabolism in the aortic wall).
- Therapeutic standard in aortic diameter <5.0 cm: beta-blockers (under imaging follow-up).
- See also under “Further therapy”.
Further notes
- Marfan syndrome: Irbesartan (AT1 -antagonist; dosage: 300 mg per die), with the highest bioavailability (80%) and half-life (11-15 hours) than other sartans, decreased dilatation (widening) of the ascending aorta in a phase III study.Mechanism: blockade of transforming growth factor beta, which is more active in Marfan syndrome. Result: there was an increase of 0.74 mm per year in the placebo group versus irbesartan group 0.53 mm per year in subsequent years (difference of 0.22 mm per year was significant with a 95% confidence interval of 0.02 to 0.41 mm per year).