New data highlight an unexpected link between hypercortisolism and resistant hypertension
Drug-resistant hypertension represents up to 13% of all hypertension cases, but it is still not fully understood. New research examining this condition was presented at ACC.26 in New Orleans by Deepak L. Bhatt, MD, MPH, MBA, director of the Mount Sinai Fuster Heart Hospital.
Bhatt shared late-breaking data from the MOMENTUM study that suggest an often-overlooked hormonal disorder may play a significant role in patients with hard-to-control blood pressure. He spoke with Cardiovascular Business about the study, which examined the prevalence and clinical implications of hypercortisolism in patients with resistant hypertension.
MOMENTUM enrolled more than 1,000 patients who met the American Heart Association definition of resistant hypertension. Using a simple overnight dexamethasone suppression test, investigators screened patients for excess cortisol production. According to Bhatt, the results were striking, with 27.3% of participants having hypercortisolism.
"That's a lot. That's way more than I would have ever expected from what I learned in medical school where when I learned about things like Cushing's disease and Cushing's syndrome. What I learned about were physical exam findings to look for, things like moon faces, a buffalo hump. But it turns out that there's a lot of hypercortisolism out there in resistant hypertension patients. And if you don't look, you don't find it," Bhatt explained.
While the observational study does not establish direct causality, the findings point to hypercortisolism as a potentially important contributor to treatment-resistant blood pressure. Bhatt said imaging data further supported this link, with about one in four patients presenting with adrenal nodules. Some of these modules could be treated surgically, which he said could potentially resolve hypertension in certain patients.
The study also evaluated hyperaldosteronism, another known driver of hypertension, and found it was present in about 20% of patients. Notably, about 6% of participants had both conditions.
Together, he said these findings reinforce current guideline recommendations to screen for hormonal causes of hypertension—and suggest clinicians may need to broaden their diagnostic approach. Bhatt also emphasized that the results could signal a shift toward more personalized care.
“We’re entering an era where hypertension won’t be treated as a single disease,” he said. “Instead, we’ll increasingly identify underlying mechanisms, like hypercortisolism or hyperaldosteronism, and tailor therapies accordingly.”
Such an approach could also help explain why some patients respond well to medications or procedures like renal denervation, but others do not. By better defining hypertension phenotypes, clinicians may be able to match patients with more effective, targeted therapies.
Ongoing research is exploring new pharmacologic treatments for cortisol-related hypertension, alongside established and emerging interventions. For now, Bhatt said, the takeaway is clear: routine screening for hormonal abnormalities may uncover treatable causes in a substantial portion of patients with resistant hypertension.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]