Long-term persistent hypertension following surgical resection of pheochromocytoma and paraganglioma

Background: Non-metastatic pheochromocytomas and paragangliomas (PPGLs) are considered a curable cause of secondary hypertension. However, some studies identified that a considerable ratio of patients (10.0-43.8%) still experience persistent hypertension even after successful resection of PPGLs. Methods: We conducted a retrospective analysis of 472 PPGL patients who underwent surgical resection at three centers from January 1, 2012, to October 31, 2022. Comprehensive clinical data were recorded. Binary unconditional logistic analysis was conducted to identify the independent variables associated with long-term persistent hypertension. Results: The cohort had an average age of 50.5 years, and the median follow-up duration was 61 months. A total of 26.3% of PPGL patients experienced long-term persistent hypertension. After multivariate analysis, we identified older age (odds ratio (OR): 1.021, P = 0.008), higher body mass index (BMI, OR: 1.088, P = 0.004), lower left ventricular ejection fraction (LVEF, OR: 3.506, P = 0.006), and developed intraoperative hemodynamic instability (HDI, OR: 2.053, P = 0.002) as independent risk factors for long-term persistent hypertension in PPGL patients. Conclusion: This study demonstrated that nearly a quarter of PPGL patients still suffer from persistent hypertension after successful resection and identified several risk factors, such as older age, higher BMI, lower LVEF, and developed intraoperative HDI. These results might contribute to improving long-term follow-up strategies.