The MOMENTUM study showed that 27 % of people with resistant high blood pressure also have too much cortisol. This tells doctors that the problem is more common than they thought.
Resistant hypertension means blood pressure stays high even after a person tries three or more medicines. About 10 million Americans have this condition. Doctors are learning that hidden health issues may stop medicines from working.
One hidden issue is hypercortisolism. That is when the body makes too much cortisol, the hormone that reacts to stress. When cortisol stays high for a long time, it can hurt the heart and cause weight gain, weak muscles, and diabetes.
Why This Matters for the Heart
People with resistant hypertension are more likely to have heart attacks or heart failure. Adding high cortisol makes the risk even bigger. Knowing that cortisol is part of the problem can help doctors find new ways to lower blood pressure.
Biggest U.S. Study of Its Kind
The MOMENTUM study is the first and largest U.S. research that counted how many resistant‑hypertension patients have high cortisol. Researchers tested 1,086 patients at 50 centers, including Mount Sinai in New York. They gave a night‑time dose of dexamethasone and measured cortisol the next morning. Anyone with cortisol above 1.8 µg/dL was labeled as having hypercortisolism.
What the Numbers Show
Out of the 1,086 people, 297 (27 %) had high cortisol. The study also found other risk factors. Patients with weaker kidneys were more likely to have the hormone problem.
Another hormone issue, primary hyperaldosteronism, appeared in about 20 % of the group. Around 6 % of the patients had both high cortisol and high aldosterone.
Next Steps for Doctors and Patients
The results suggest doctors should check cortisol levels in patients whose blood pressure is hard to control. The test is simple, and many patients want to know why their medicines aren’t working.
Patients taking several blood‑pressure pills should ask their doctor about a cortisol screening.
Expert View
"Finding that more than a quarter of resistant‑hypertension patients have high cortisol is very different from what doctors learned in school. This should make us test for cortisol more often," says Dr. Deepak L. Bhatt.
He adds, "Future studies need to see if treatments that lower cortisol can safely bring blood pressure down."
Study Support
The research was funded by Corcept Therapeutics. Dr. Bhatt is a paid consultant for the company. The findings were presented at the American College of Cardiology’s Annual Scientific Session.