Aortic Disease Recommendation for Management of Hypertension in Patients With Aortic Disease COR LOE Recommendation I C-EO 1. Beta blockers are recommended as the preferred antihypertensive agents in patients with hypertension and thoracic aortic Synopsis Thoracic aortic aneurysms are generally asymptomatic until a person presents with a sudden catastrophic event, such as an aortic dissection or rupture, which is rapidly fatal in the majority of patients.S9.10-3,S9.10-4 The rationale for antihyperten- sive therapy is based largely on animal and observational stud- ies associating hypertension with aortic dissection.S9.10-5,S9.10-6 RCTs specifically addressing hypertension and aortic dis- ease are not available, and trials in patients with primary hypertension do not provide insight on either the optimal BP target or choice of antihypertensive drug therapy in patients with thoracic aortic aneurysm, aortic dissection, or aortic A study in 20 humans with hypertension suggested that hypertension is associated with significant changes in the mechanical properties of the aortic wall, with more strain-induced stiffening in hypertension than in normo- tension, which may reflect destruction of elastin and predispo- sition to aortic dissection in the presence of hypertension.S9.10-9 In a retrospective observational study, high BP variability was an independent risk factor for the prognosis of aortic Recommendations for treatment of acute aor- tic dissection are provided in Section 11.2. Recommendation-Specific Supportive Text 1. In patients with chronic aortic dissection, observational studies suggest lower risk for operative repair with beta- In a series of patients with type A and type B aortic dissections, beta blockers were asso- ciated with improved survival in both groups, whereas ACE inhibitors did not improve survival.S9.10-2 10. Special Patient Groups Special attention is needed for specific patient subgroups. 10.1. 