For millions of Americans, managing high blood pressure is a lifelong battle. But what if the reason your numbers won’t budge isn’t a matter of diet or exercise, or even medication adherence, but an overlooked hormonal imbalance? A groundbreaking new study suggests that excess cortisol – often called the “stress hormone” – could be a significant, and often undetected, contributor to resistant hypertension, a particularly challenging form of the condition affecting nearly 10 million people in the United States.
Resistant hypertension is defined as blood pressure that remains elevated despite taking three or more different types of blood pressure medication. This isn’t simply a matter of needing a higher dose; it signals that something else is at play, actively working against the treatments. Researchers are increasingly focused on identifying these underlying causes, and the recent findings point to hypercortisolism – a condition where the body produces too much cortisol – as a surprisingly common culprit.
Cortisol is essential for life, regulating metabolism, inflammation, and the body’s response to stress. However, chronically elevated levels can wreak havoc on health, contributing to weight gain, muscle loss, type 2 diabetes, and, crucially, increased blood pressure. The new research, presented at the American College of Cardiology’s Annual Scientific Session, reveals just how prevalent hypercortisolism may be in those struggling to control their blood pressure.
The MOMENTUM Study: A New Perspective on Resistant Hypertension
The study, dubbed “MOMENTUM,” is the largest U.S. Investigation to date examining the link between hypercortisolism and resistant hypertension. Researchers evaluated 1,086 participants with confirmed resistant hypertension across 50 medical centers nationwide, including Mount Sinai Health System in New York. Participants underwent a dexamethasone suppression test, a standard method for assessing cortisol levels. This test involves taking a small dose of dexamethasone, a synthetic corticosteroid, at night, followed by a blood draw the next morning. A cortisol level above 1.8 ug/dL was considered indicative of hypercortisolism.
The results were striking: 27 percent – 297 out of 1,086 participants – were found to have hypercortisolism. This is significantly higher than previously estimated, suggesting that excess cortisol may be a far more common driver of resistant hypertension than many clinicians realize. “The fact that such a high percentage (more than 25 percent) of patients with resistant hypertension have elevated cortisol levels is remarkably different from what doctors have been historically taught in medical school,” explained Deepak L. Bhatt, MD, MPH, MBA, a leading cardiologist and researcher, in a statement about the study.
Beyond Cortisol: Other Factors at Play
While hypercortisolism emerged as a key finding, the MOMENTUM study likewise highlighted the importance of considering other hormonal imbalances. Approximately 20 percent of participants were diagnosed with primary hyperaldosteronism, a condition involving the overproduction of aldosterone, another hormone that regulates blood pressure. Notably, around 6 percent of participants had both hypercortisolism and hyperaldosteronism, suggesting that multiple hormonal factors can contribute to resistant hypertension in some individuals.
Researchers also observed a correlation between reduced kidney function and elevated cortisol levels. This finding underscores the complex interplay between kidney health, hormonal regulation, and blood pressure control. Chronic kidney disease is a known risk factor for hypertension, and this study suggests that cortisol may play a mediating role in that relationship.
What Does This Mean for Patients and Their Doctors?
The implications of the MOMENTUM study are significant. The findings suggest that physicians should proactively consider hypercortisolism as a potential cause of resistant hypertension, particularly in patients with risk factors such as kidney disease. The dexamethasone suppression test is a relatively simple and readily available diagnostic tool, and many patients are understandably eager to explore all possible explanations for their persistent high blood pressure.
“These findings should prompt more screening for excess levels of cortisol in patients with resistant hypertension,” Dr. Bhatt emphasized. He added that further research, including randomized controlled trials, is needed to determine whether therapies specifically targeting cortisol can safely and effectively lower blood pressure in these patients. Currently, treatment options for hypercortisolism range from medication to, in some cases, surgical removal of the cortisol-producing tumor (if one is present).
For patients whose blood pressure remains stubbornly high despite multiple medications, discussing screening for hypercortisolism with their doctor is a reasonable next step. Early diagnosis and appropriate treatment could potentially offer a new path toward better blood pressure control and reduced cardiovascular risk.
Study Funding and Disclosure: Corcept Therapeutics Incorporated sponsored and funded the MOMENTUM study. Dr. Bhatt is a paid consultant for Corcept Therapeutics Incorporated.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It’s essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
The research team plans to continue investigating the underlying mechanisms linking cortisol to resistant hypertension and to explore potential therapeutic strategies. The next step will be to conduct larger, more comprehensive trials to validate these findings and determine the optimal approach to managing this often-overlooked contributor to cardiovascular disease.
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