Beta-blockers are favored as the first-line agent in patients with aortic dissection. When antihypertensive therapy is warranted, the main issue is to limit the shear wall forces on the aorta. The importance of the beta-blocker is to prevent rebound tachycardia when nitrates are used. An ideal combination is esmolol followed by nitroprusside since they can be titrated well and have short half-lives. Hydralazine and lisinopril have no role in the antihypertensive therapy of aortic dissection patients.