A new study presented at the American College of Cardiology Scientific Session on Mar. 28 found that more than a quarter of patients with resistant hypertension also have hypercortisolism, according to Deepak L. Bhatt, MD, MPH, MBA, lead investigator and professor at the Icahn School of Medicine at Mount Sinai.
The findings are significant because they suggest that many people whose blood pressure remains high despite taking multiple medications may have an underlying hormonal condition. Hypercortisolism occurs when the body produces too much cortisol, a hormone associated with stress response but potentially harmful when elevated long-term.
Researchers conducted the MOMENTUM study by analyzing 1,086 participants from 50 centers across the United States. Participants underwent a dexamethasone suppression test to measure cortisol levels; those with levels above 1.8 ug/dL were classified as having hypercortisolism. The results showed that 27 percent—297 out of 1,086—had this condition.
Bhatt said: "The fact that such a high percentage (more than 25 percent) of patients with resistant hypertension have elevated cortisol levels is very different from what doctors have been historically taught in medical school. These findings should prompt more screening for excess levels of cortisol in patients with resistant hypertension." He added: "The next step to further this research is conducting randomized trials to determine if therapies that lower the impact of cortisol can safely and effectively treat high blood pressure in these patients."
In addition to hypercortisolism, about one-fifth of participants had primary hyperaldosteronism—a separate hormonal disorder—and around six percent had both conditions simultaneously. The study also found that poor kidney function was linked to higher rates of hypercortisolism among participants.
Physicians are encouraged to consider testing for elevated cortisol in cases where blood pressure does not respond well to standard treatments. The study suggests screening is straightforward and may help identify why some individuals struggle to control their blood pressure.
