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| Subject | Evidence summary | Level of evidence | Recommended class |
|
| Target value | (1) Assess the presence or absence of target organ damage and use this to determine target blood pressure values and the time to achieve it | 1 | A |
| (2) Initial target: Strict target heart rate <60/min or loose target heart rate <80/min, systolic blood pressure 100–120 mmHg or <130/80 mmHg (in combination with diabetes or chronic renal failure); for hemodynamically unstable AAD ruptures, maintain systolic blood pressure. 130/80 mmHg (in combination with diabetes mellitus or chronic renal failure); for hemodynamically unstable AAD ruptures, maintain systolic blood pressure | 4 | A |
| (3) The recommendation is to reduce to the initial target value within 20–30 min while ensuring organ perfusion | 5 | B |
|
| Management strategy | (4) Initial treatment is blood pressure and heart rate control | 5 | B |
| (5) The “hypotensive haemostasis” strategy of restrictive fluid resuscitation is recommended for the haemodynamically unstable | 1 | A |
| (6) Emergency surgery recommended for AAD rupture and hemodynamic instability | 1 | B |
| (7) Decision-making must be individualised, taking into account patients’ coexisting conditions (e.g., stroke, renal failure, and diabetes), age and the expectations of patients and families | 1 | A |
| (8) Recommended multidisciplinary team treatment | 5 | A |
|
| Disease observation | (9) Recommend dynamic assessment of patient symptoms and hemodynamic status in the emergency room | 1 | A |
| (10) The extent and severity of AAD involvement can be inferred from arterial pulses and blood pressure values at different locations | 1 | A |
| (11) If hypertension is poorly controlled with increased creatinine, decreased hourly urine output or back pain, suspect the presence of renal ischaemia | 1 | A |
| (12) Severe chest, abdominal, low back or back pain with hypotension, consider AAD rupture | 1 | A |
| (13) The presence of an odd pulse should be checked for hypotension to assess for pericardial tamponade; when systolic blood pressure is <90 mmHg or shock index >1 and pericardial effusion is present 1 pericardiocentesis is not recommended when systolic blood pressure is <90 mmHg or shock index >1 and pericardial fluid is present 1 | 1 | A |
| (14) Hypotension, systolic pressure difference between the arms >20 mmHg or absence of arterial pulsation in the proximal limb are high-risk signs and may guide the initial diagnosis | 1 | A |
|
| History-taking | (15) Any history of hypertension, diabetes, aortic intervention, aortic valve disease, Marfan syndrome or family history | 1 | A |
| (16) History of specific drug use, like cocaine, methamphetamine | 1 | A |
|
| Monitoring instruments | (17) Recommended measurement of blood pressure in the extremities | 1 | A |
| (18) Recommended invasive arterial blood pressure test | 1 | A |
| | (19) SwanGanz catheter and central venous pressure monitoring when severe hemodynamic disturbances are present | 1 | B |
| Vasoactive agents | (20) Combined antihypertensive drug therapy is recommended | 1 | A |
| (21) 2 large diameter peripheral venous catheters are recommended to facilitate drug administration | 1 | A |
| (22) The recommended initial treatment is an intravenous infusion of a beta-blocker, esmolol preferred, administered as a loading dose of 250−500 μg/kg over 1 min, followed by at a rate of 25 to 50 μg·kg−1·min−1; maximum dose 300 μg·kg−1·min−1 | 1 | A |
| (23) Beta-blockers are contraindicated (e.g., asthma, heart failure, chronic obstructive pulmonary disease, or atrioventricular block) or used with caution (athletes, aortic angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists). Change nondihydropyridine calcium channel blockers, such as diltiazem, verapamil | 5 | A |
| (24) If beta-blockers fail to lower blood pressure sufficiently, a combination of sodium nitroprusside at an initial dose of 0.25–0.50 μg·kg−1·min−1 and a maximum dose of 10 μg·kg−1·min−1 is recommended(no more than 10 min); use away from light and monitor closely for blood pressure changes and signs of cyanide toxicity; use with caution in renal insufficiency | 1 | A |
| (25) For AAD involving coronary arteries, nitroglycerin is recommended at a starting dose of 5 μg/min and a maximum dose of 100 μg/min, with observation for headache and tachycardia tachycardia | 1 | A |
| (26) For patients with renal impairment, fenoldopam is recommended at a starting dose of 0.1 μg·kg−1·min−1, which can be adjusted every 15 min up to 1.6 μg·kg−1·min−1, with caution or contraindicated in patients with glaucoma; with caution in patients with sulphite sensitivity | 1 | A |
| (27) ACEI or other vasodilators are recommended when the heart rate is <60 beats/min and systolic blood pressure remains above 120 mmHg, maintain adequate end-stage organ perfusion | 1 | B |
| (28) Vasodilators alone should not be used until the heart rate is controlled | 1 | A |
| (29) There are limited medications available to treat AAD with hypotension, and moderate rehydration is recommended.need to be assessed before rehydration, vasopressin may also be used, close monitoring for signs of entrapment progression is required | 1 | B |
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| Nonvascular active drugs | (30) Recommend analgesic treatment such as morphine and pethidine | 1 | A |
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| Relevant examinations | (31) Auscultation of the heart rhythm, presence of murmurs and additional heart sounds | 1 | A |
| (32) Complete ECG, routine urine, routine blood, biochemistry, cardiac markers, coagulation, arterial blood gases, cephalothoracic and cephalothorax and abdomen CT or transesophageal echocardiography to assess for target organ damage | 5 | A |
| (33) Aortic CT angiography is recommended for hemodynamically stable patients; emergency bedside transesophageal echocardiography or transthoracic wall echocardiography is recommended for unstable patients; magnetic resonance angiography is usually the test of choice for hemodynamically stable patients with renal insufficiency | 3 | A |
|
| Patient education | (34) Absolute bed rest and avoid strenuous activity, heavy lifting, coughing and bowel movements | 1 | A |
| (35) Recommend suspension of cocaine, bupropion, varenicline, and so on | 1 | A |
| (36) Inform patients and their families of the risk factors associated with hypertension, recommend smoking cessation, educate them about the disease and provide psychological support | 1 | A |
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