The MOMENTUM study found that 27% of patients with resistant hypertension exhibit hypercortisolism, indicating that excess cortisol is more common in this group than previously thought.

Resistant Hypertension and Hypercortisolism

Resistant hypertension is defined by persistently high blood pressure despite taking three or more antihypertensive medications. In the United States, about 10 million people are affected by this condition. One possible reason for the ineffectiveness of standard therapy may be underlying health disorders, including hypercortisolism—a state in which the body produces excessive amounts of cortisol. Cortisol, often called the “stress hormone,” helps regulate the body’s response to stress, but chronically elevated levels can lead to serious complications.

Risks and Complications

Patients with resistant hypertension face a higher risk of cardiovascular events such as heart attack and heart failure. Hypercortisolism is also associated with weight gain, muscle loss, and the development of diabetes. Detecting excess cortisol may help explain why some patients struggle to control their blood pressure and could open the door to alternative treatment options if standard approaches are ineffective.

The MOMENTUM Study Process

The MOMENTUM study was the first and largest of its kind in the U.S. to examine the prevalence of hypercortisolism among patients with resistant hypertension. A total of 1,086 participants from 50 medical centers nationwide, including the Mount Sinai Health System in New York, took part. After meeting selection criteria, participants underwent a dexamethasone suppression test: they took a dose of the medication in the evening, and their blood cortisol levels were measured the next morning. Patients with cortisol levels above 1.8 mcg/dL were classified as having hypercortisolism.

Key Findings

Out of 1,086 participants, 297 were found to have hypercortisolism, representing 27% of the group. The study also identified factors that increase the likelihood of developing this condition; for example, impaired kidney function was more often associated with elevated cortisol levels.

Related Conditions

Resistant hypertension is also linked to primary hyperaldosteronism—a condition in which the body produces too much aldosterone. About 20% of participants had this disorder, and approximately 6% were found to have both hypercortisolism and hyperaldosteronism.

Practical Recommendations

The data suggest that doctors should consider elevated cortisol as a possible cause of resistant hypertension and screen at-risk patients accordingly. Testing for hypercortisolism is relatively straightforward, and many patients are interested in identifying the reasons behind their difficulties in controlling blood pressure.

Outlook

Patients whose blood pressure remains high despite taking several medications are advised to discuss the possibility of hypercortisolism screening with their doctor. The high proportion of patients with resistant hypertension and elevated cortisol levels challenges previous assumptions and may justify broader screening for cortisol excess. The next step will be randomized studies to determine whether methods to reduce cortisol can safely and effectively treat high blood pressure in these patients.