Esmolol in Acute Settings

Clinical Indications and Usage

The European Heart Journal recommends esmolol as a first-line treatment for acute aortic disease to rapidly reduce systolic BP and heart rate to 120 mmHg or lower and 60 bpm or less to reduce aortic wall stress and disease progression 1
In patients with aortic dissection, esmolol can be used together with ultra-short acting vasodilating agents such as nitroprusside or clevidipine 1
For patients with both cardiovascular disease and reactive airway disease, esmolol offers a safer profile than longer-acting beta blockers, according to the American Heart Association, as reported in Circulation 4, 5

Landiolol is another ultra-short acting beta blocker (about eight times more selective for beta-1 receptors than esmolol) but is less widely available 2
Non-dihydropyridine calcium channel blockers (verapamil or diltiazem) can be considered as alternative therapy for conditions like angina or hypertension in patients with absolute contraindications to beta blockers, as suggested by the American College of Cardiology 4, 5