What are the key considerations for managing hypertension in a patient diagnosed with phaeochromocytoma?

Key considerations for managing hypertension in a patient diagnosed with phaeochromocytoma include:

• Urgent specialist referral: Patients with suspected phaeochromocytoma should be referred for same-day specialist assessment due to the risk of labile or severe hypertension and associated symptoms such as headache, palpitations, pallor, abdominal pain, or diaphoresis.
• Blood pressure control with alpha-blockade: Initial management typically involves alpha-adrenergic blockade to control hypertension and prevent hypertensive crises, as beta-blockers alone can worsen hypertension by causing unopposed alpha-adrenergic receptor stimulation.
• Careful use of beta-blockers: Beta-blockers may be added only after adequate alpha-blockade is established, especially if tachycardia or arrhythmias are present.
• Monitoring and managing blood potassium levels: Consider alpha-blockers or beta-blockers in patients with resistant hypertension and blood potassium levels above 4.5 mmol/L, but specialist advice is essential.
• Preoperative preparation: Adequate blood pressure control before surgical resection of the tumour is critical to reduce perioperative cardiovascular risks.
• Lifestyle advice and monitoring: Although lifestyle interventions are important in hypertension management generally, in phaeochromocytoma, pharmacological control and specialist management take precedence.

These considerations align with NICE guidance recommending urgent specialist referral for suspected phaeochromocytoma and the use of alpha-blockers as part of resistant hypertension management, with specialist input for complex cases ¹,⁴.