After initial assessment, which medication strategy might be considered inappropriate for a patient with elevated blood pressure and suspected aortic dissection?

The use of hydralazine in the context of a patient with elevated blood pressure and suspected aortic dissection is considered inappropriate due to its mechanisms of action and effects on hemodynamics. Hydralazine is a direct vasodilator that primarily induces relaxation of arterial smooth muscle. While it can effectively lower blood pressure, it does so through peripheral vasodilation and may lead to reflex tachycardia and increased myocardial oxygen demand as a compensatory response. This unwanted increase in heart rate can be particularly hazardous in cases of aortic dissection, where it is essential to maintain lower heart rates to minimize stress on the aorta and reduce the risk of progression or complications arising from the dissection.

In cases of suspected aortic dissection, medications that provide both blood pressure control and rate control, such as esmolol or nitroprusside, are often more appropriate. Esmolol, a beta-blocker, helps to reduce heart rate and myocardial contractility, providing a protective effect on the aorta by decreasing the shear stress. Nitroprusside is also effective in rapidly lowering blood pressure in a controlled manner, but it does not directly influence heart rate.

Enalaprilat is an angiotensin-converting enzyme