A patient with hypeension is also having aoic dissection. Anti-hypeensive agent of choice is: September 2008
**Core Concept**
Aortic dissection is a life-threatening condition where there is a tear in the inner layer of the aorta, leading to bleeding and potential rupture. In this scenario, the patient's hypertension exacerbates the condition, requiring immediate blood pressure control to prevent further dissection or rupture. Sodium nitroprusside is an ideal agent for this purpose due to its rapid onset and short duration of action, allowing for precise control of blood pressure.
**Why the Correct Answer is Right**
Sodium nitroprusside is a potent vasodilator that acts on both arteries and veins to lower blood pressure. It works by releasing nitric oxide, which relaxes smooth muscle cells in blood vessels, leading to vasodilation. This effect is rapid and dose-dependent, making it an ideal choice for acute blood pressure management in patients with aortic dissection. The addition of sodium nitroprusside to a patient's existing antihypertensive regimen can help rapidly lower blood pressure and reduce the risk of further dissection or rupture.
**Why Each Wrong Option is Incorrect**
**Option B:** Reserpine is an antipsychotic and antihypertensive agent that works by depleting catecholamines from nerve terminals. However, it is not suitable for acute blood pressure management in patients with aortic dissection due to its delayed onset of action and potential for causing orthostatic hypotension.
**Option C:** Pindolol is a beta-blocker that can be used to manage hypertension, but it is not the best choice in this scenario due to its potential to worsen aortic dissection by causing vasoconstriction and increasing afterload.
**Option D:** Nifedipine is a calcium channel blocker that can be used to manage hypertension, but it is not the best choice in this scenario due to its potential to cause reflex tachycardia and worsen aortic dissection.
**Clinical Pearl / High-Yield Fact**
When managing hypertension in patients with aortic dissection, it is essential to use agents that can rapidly lower blood pressure without causing significant vasodilation or reflex tachycardia. Sodium nitroprusside is a safe and effective choice for this purpose, but its use should be carefully monitored to avoid potential side effects such as thiocyanate toxicity.
**✓ Correct Answer:** A. Sodium nitroprusside