The treatment of hypertension in phaeochromocytoma is with alpha blockade prior to beta blockade. Alpha blockade reverses the peripheral vasoconstriction whereas beta blockade prevents tachycardia. The preferred alpha-blocker phenoxybenzamine, as it is not a selective alpha 1 blocker but an irreversible alpha-blocker whose effects cannot be overcome by an increase of catecholamines. Hypertension should be managed with phenoxybenzamine initially, increasing up to 80 mg per day, with addition of propanolol after 3-4 days of alpha blockade. Surgery without adequate alpha and beta blockade can result in hypertensive crisis (leading to high CVA, MI complications).