Resistant hypertension occurs when blood pressure remains high even after taking three or more medications. Nearly 10 million people in the United States are affected by this condition. Researchers are increasingly recognizing that underlying health issues may be preventing standard treatments from working.

One of those issues is hypercortisolism, a condition in which the body produces too much cortisol. Often called the “stress hormone,” cortisol helps regulate the body’s response to stress. However, when cortisol levels stay elevated over time, it can lead to serious health problems.

Why This Discovery Matters for Heart Health

Patients with resistant hypertension face a higher risk of serious cardiovascular events such as heart attacks and heart failure. At the same time, hypercortisolism is linked to complications including weight gain, muscle loss, and diabetes.

Identifying excess cortisol as a contributing factor may help explain why some patients struggle to control their blood pressure. It also opens the possibility that treating hypercortisolism could provide a new way to lower blood pressure when standard therapies are not effective.

Largest U.S. Study of Its Kind

“MOMENTUM” is the first study conducted in the United States and the largest to date to measure how common hypercortisolism is among patients with resistant hypertension.

Researchers evaluated 1,086 participants across 50 centers nationwide, including Mount Sinai Health System in New York. After confirming eligibility, participants underwent a dexamethasone suppression test. This involved taking a dose of dexamethasone at night and having blood drawn the next morning to measure cortisol levels. Patients with cortisol levels above 1.8 ug/dL were classified as having hypercortisolism.

Study Results and Additional Risk Factors

Out of 1,086 participants, 297 were found to have hypercortisolism, representing 27 percent of the group.

The study also identified factors that increase the likelihood of having this condition. For instance, patients with reduced kidney function were more likely to have elevated cortisol levels.

Another condition linked to resistant hypertension is “primary hyperaldosteronism,” which occurs when the body produces too much aldosterone. About 20 percent of participants had this disorder, and roughly 6 percent had both hypercortisolism and hyperaldosteronism.

What Patients and Doctors Should Do Next

The findings suggest that physicians should consider elevated cortisol as a possible cause of resistant hypertension and screen patients who are at higher risk. Testing is relatively simple, and many patients are eager to find an explanation for why their blood pressure remains difficult to control.

Patients whose blood pressure stays high despite multiple medications may benefit from asking their doctor about screening for hypercortisolism.

Expert Perspective

“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,” says Deepak L. Bhatt, MD, MPH, MBA. “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.”

Study Funding and Presentation

Study Funding: Corcept Therapeutics Incorporated was the study sponsor and funded the study. Dr. Bhatt is a paid consultant for Corcept Therapeutics Incorporated.

Meeting: American College of Cardiology’s Annual Scientific Session