Transdermal patch of bisoprolol for the treatment of hypertension complicated with aortic dissection

Abstract

A 63-year-old man presented to a clinic because of sudden onset of severe longitudinal back pain and was transferred to the intensive care unit (ICU) of our hospital. He had been hypertensive for 30 years; however, he had never been referred to a clinic for treatment. Physical examination findings were unremarkable, except for high blood pressure (BP) (220/110mmHg) and heart rate (80 beats/min). Electrocardiography and chest radiography findings were normal. Blood examination showed leukocytosis (9700/μL) without an increased plasma fibrin degradation products level (2 μg/mL). The patient was diagnosed with acute type B aortic dissection (AD) with a thrombosed false lumen by enhanced computed tomography (Fig. 1). We administered an 8-mg/day transdermal patch of bisoprolol after titration of intravenous nicardipine (Fig. 2). Six hours later, systolic BP decreased to 112 mm Hg and heart rate decreased to 54 beats/min. Additionally, the ventricular force (dP/dt) of aortic pressure decreased over time. After intravenous nicardipine was withdrawn, 40 mg of olmesartan, 80 mg of nifedipine, and 2 mg of doxazosin in addition to the 8-mg transdermal patch of bisoprolol were administered, and systolic BP was well controlled to b120 mm Hg. He was discharged 23 days after the onset of AD without any complication. BP reduction is critical to preventing lethal complications, including enlargement of aortic aneurysm and aortic rupture in the acute phase [1]. dP/dt and stress on the aorta are risk factors, and therefore, β-blockers should be the first drug of choice because they have negative chronotropic and negative inotropic effects [2]. Maintaining systolic BP between 100 and 120 mm Hg with a heart rate b60 beats/min is an attainable temporal goal [3], which was achieved with intravenous nicardipine and transdermal bisoprolol in the present case. However, in many cases, multiple BP-lowering agents are required to achieve this goal. Intravenous agents should be chosen for controlling BP because of the need for titration of the dose, especially in patients with a