This study has been performed so that Arterial hypertension (HTN) is considered a seminal risk factor for aortic dissection (AD). The impact of chronic HTN control on the location, extent, and early outcome of acute AD has not been evaluated. The purpose of this study was to evaluate whether pre-existing blood pressure (BP) control lessens the extent of dissection and has a favorable impact on the outcome of patients with acute AD. Consecutive patients admitted from 2011 to 2019 who had a most recent BP recorded within a mean of 4 ± 3 months before the AD were retrospectively analyzed. HTN was defined as normal (BP <140/90 mm Hg), stage 1 (BP >140/90 mm Hg and <160/100 mm Hg), or stage 2 or higher (BP >160/100 mm Hg). The number of hypertensive medications (MEDs) was used as a surrogate marker of HTN severity. The degree of pre-existing HTN control had no bearing on the type or extent of AD, length of stay, or early outcome. Regardless of the state of HTN control before AD, the consistent and sustained increase in the severity of HTN after AD suggests that the dissection process has a profound and lasting effect on BP regulation. Further studies are indicated to elucidate the pathologic mechanisms involved in AD.