Control of blood pressure and heart rate of hypertension with acute aortic dissection treated by diltiazem combined with esmolol

AIM To evaluate the effects of diltiazem combined with esmolol on blood pressure(BP) and heart rate(HR) in patients with hypertension and acute aortic dissection(AD).METHODS Seventy-two patients with hypertension and acute AD were divided into the control group(n = 36) and the experimental group(n = 36) according to sequential trial methodology.Patients in the control group were injected with sodium nitroprusside 1.5 μg·kg-1·min-1 to control BP,whose dosage was adjusted according to BP response,and administered orally with metoprolol 25 mg to control the HR.Patients in the experimental group were first injected with diltiazem 10 mg intravenously,and followed by the dose of 5 μg·kg-1·min-1 continuous intravenously.When necessary,BP was controlled by repeating intravenous injection of diltiazem 0.1 mg·kg-1.HR was controlled with the first dose of esmolol 200 μg·kg-1·min-1 intravenously,followed by the dose of 50 μg·kg-1.min-1 to maintain HR.The BP and HR of all patients were monitored at 0.5h,1h,and 6h.RESULTS There was no significant difference(P 0.05) in BP and HR at 0 h between two groups.There was a significant difference(P 0.05) in BP,HR and rate-pressure product(RPP) 6 h after the treatment.BP control rates in the control group and the experimental group were 67% and 89%,and the HR control rates were 36% and 94%,respectively.Control rate of both BP and HR were 31% in the control group and 84% in the experimental group,there was a significant difference(P 0.01).There was no significant difference (P 0.05) in adverse reaction rates between two groups.CONCLUSION With no more adverse reactions,diltiazem combined with esmolol is more effective than conventional nitroprusside combined with metoprolol in patients with hypertension and AD.