Medical management is generally the preferred treatment for uncomplicated type B acute aortic dissection cases. It is often centered on the use of antihypertensive agents, which alleviates hemodynamic stress on the damaged aortic wall. Methods of medical management and drug selection are still based mainly on personal experience, expert opinion and historical observational studies as randomized controlled studies are lacking. Guidelines from European (ESC), American (ACC/AHA) and Asian (Japan) societies in the last decade have made recommendations on use of medications, but also reaffirmed the lack of evidence for therapeutic approaches and targeted medical management. More recent evidence suggests that there may be type-selective benefits for antihypertensive medications. Here, we will discuss the present understanding of medical management of acute aortic dissection.