What is the first-line medication class for the treatment of aortic dissection?

For the treatment of aortic dissection, beta-blockers are the first-line medication class. This is primarily because they effectively reduce the heart rate and decrease the force of myocardial contraction, which in turn lowers the left ventricular wall stress and the overall blood pressure. These effects help to minimize the propagation of the dissection by reducing the hemodynamic stress on the aortic wall.

Beta-blockers, particularly those that are cardioselective, provide a rapid response in controlling blood pressure as well as heart rate, which is critical in managing the acute clinical situation of aortic dissection. Studies and clinical guidelines emphasize the importance of these drugs in managing dissection, particularly in type A dissections, where prompt control of heart rate and blood pressure can stabilize the patient before surgical interventions.

Other classes of medications, while they might have supportive roles or be used in combination therapy for hypertension in broader clinical settings, do not have the same first-line status for aortic dissection. For instance, although ACE inhibitors are used for chronic hypertension and heart failure management, they do not provide the rapid control of the cardiovascular parameters needed in the acute setting of an aortic dissection. Similarly, while calcium channel blockers and nitrates can lower blood pressure, they are not