Drug Therapy of Dissecting Aortic Aneurysms

The records of 56 patients with proved acute aortic dissection were studied for factors bearing on the applicability of vigorous drug therapy to reduce arterial pressure. Fourteen patients had an arterial pressure of 120 mm Hg systolic or less. Fifteen additional patients had evidence of occlusion of a major branch of the aorta. More than half of the 56 patients, therefore, could not have received antihypertensive drugs. The presence of a contraindication to drug therapy marked a patient for an early death. All 29 died within 2 weeks. Twelve of the 27 in whom no contraindications to drug therapy were observed survived more than 2 weeks and six survived more than a year even though none were placed on a vigorous antihypertensive regimen. Assessment of the efficacy of drug therapy of dissecting aortic aneurysm should take into account these facets of the natural history.