A large U.S. study has found that 27 percent of patients with resistant hypertension have hypercortisolism, an excess of the stress hormone cortisol. The MOMENTUM study, involving 1,086 participants across 50 centers, showed this condition is far more common than previously thought in those whose blood pressure remains high despite multiple medications. The discovery suggests screening for elevated cortisol could help explain treatment failures.
The MOMENTUM study, the largest of its kind in the United States, evaluated patients with resistant hypertension—a condition affecting nearly 10 million Americans where blood pressure stays elevated despite three or more medications. Researchers used a dexamethasone suppression test, where participants took the drug at night and had blood drawn the next morning. Those with cortisol levels above 1.8 ug/dL were diagnosed with hypercortisolism; 297 out of 1,086 qualified, or 27 percent of the group. Centers including Mount Sinai Health System in New York participated in the nationwide effort, with results presented at the American College of Cardiology's Annual Scientific Session. Patients with reduced kidney function were more likely to have elevated cortisol. About 20 percent of participants also had primary hyperaldosteronism, excess aldosterone production, and roughly 6 percent had both conditions. Hypercortisolism and resistant hypertension both raise risks for heart attacks, heart failure, weight gain, muscle loss, and diabetes. Deepak L. Bhatt, MD, MPH, MBA, stated, '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.' The study was funded by Corcept Therapeutics Incorporated, for which Bhatt serves as a paid consultant. Physicians now recommend considering cortisol screening for at-risk patients, as the test is simple and could guide new treatments.
