Nonselective Compared With Selective -Blockade Is Associated With Less Intraoperative Hypertension in Patients With Pheochromocytomas and Paragangliomas: A Retrospective Cohort Study With Propensity Score Matching

Background: Both selective and nonselective alpha-blockade are used for preoperative preparation in patients with pheochromocytomas and paragangliomas (PPGLs). However, the effects of different types of alpha-blockade on perioperative outcomes remain inconclusive. This study was designed to assess the association between the choice of alpha-blockade and the amount of intraoperative hypertension in patients undergoing surgery for PPGLs. METHODS: In this propensity-matched retrospective cohort study, data of patients who received either selective or nonselective alpha-blockade preoperatively and underwent surgery for PPGLs were collected. The primary end point was the time-weighted average above the systolic blood pressure (SBP) of 160 mm Hg (TWA-SBP >160 mm Hg), which was calculated as the total area of the SBP-time curve above the SBP of 160 mm Hg and divided by anesthesia duration. RESULTS: A total of 286 patients were included in analysis; of them, 156 received selective alpha-blockade and 130 nonselective alpha-blockade. After propensity score matching, 89 patients remained in each group. Patients who received nonselective alpha-blockade had a lower TWA-SBP >160 (median 0.472 mm Hg, interquartile range [IQR], 0.081-1.300) versus those who received selective alpha-blockade (median 1.114 mm Hg, IQR, 0.162-2.853; median difference -0.391, 95% confidence interval [CI], -0.828 to -0.032; P = .016); they also had a lower highest SBP during surgery (193 +/- 24 mm Hg versus 205 +/- 34 mm Hg; mean difference -12, 95% CI, -20 to -3; P = .008). Postoperative outcomes did not differ significantly between the 2 groups. CONCLUSIONS: For patients undergoing surgery for PPGLs, preoperative nonselective alpha-blockade was associated with less intraoperative hypertension when compared with selective alpha-blockade.