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 CORTISOL MAY BE THE DRIVER OF RESISTANT HYPERTENSION




You take your blood pressure meds. You watch your salt. You do everything right—so why won’t those numbers budge? A major new study from Mount Sinai suggests the answer might be hiding in plain sight: your hormones, specifically cortisol.

Cortisol is often called the “stress hormone.” It’s what gets you through a tough day at work or a late-night deadline. But when your body pumps out too much of it for too long, things can go haywire—especially your blood pressure.

The MOMENTUM study, the largest of its kind in the U.S., found something surprising: more than a quarter of people with stubborn, hard-to-treat high blood pressure had elevated cortisol. That’s 27% of patients—far beyond what doctors ever expected. And for the nearly 10 million Americans with so-called “resistant hypertension” (high blood pressure that sticks around no matter how many pills you take), this could finally be a missing piece of the puzzle.

What Is Resistant Hypertension, Anyway?

If your blood pressure stays high even after three or more medications, you’re not alone. Doctors call this “resistant hypertension,” and it’s a real headache—literally and figuratively. Besides making your doctor (and you) frustrated, it raises your risk of heart attacks, heart failure, diabetes, and other serious problems.

Why Cortisol Matters

Cortisol isn’t just about stress. When levels stay high over time, it can cause weight gain, muscle loss, and even mess with your blood sugar. For years, doctors thought this was rare. Now, the MOMENTUM study shows it’s actually pretty common among people whose blood pressure won’t budge.

The Study: What They Did and What They Found

Researchers studied over 1,000 patients across 50 medical centers, including Mount Sinai in New York. Everyone took a simple overnight pill and had their blood tested the next morning. If their cortisol was above a certain level, they were flagged for “hypercortisolism”—meaning their body was making too much of the hormone.

The results? Of 1,086 participants, 297 had high cortisol levels. That’s 27%. On top of that, people with kidney issues were even more likely to have this hidden hormone problem.

And it doesn’t stop there. The study also looked at another hormone, aldosterone, which can raise blood pressure. About 20% of the group had high aldosterone, and 6% had both hormone problems at the same time.

What Should You Do?

If you’re struggling to control your blood pressure, it might be time to ask your doctor about hormone testing. Screening for high cortisol is simple, and it could give you answers when nothing else has worked. Doctors are being urged to look beyond the usual suspects and test for these hidden hormone imbalances.

Expert Take

“This changes everything,” says Dr. Deepak L. Bhatt, one of the lead researchers. “More than 25% of patients with resistant hypertension have high cortisol—much more than we thought. Now, the next step is to test whether lowering cortisol can actually help bring blood pressure down for these patients.”

The Bottom Line

If your blood pressure isn’t budging—despite trying multiple treatments—don’t give up. There might be a hidden hormone at play, and now, there’s finally a way to find it.

Funding Note: This research was sponsored by Corcept Therapeutics Incorporated, with Dr. Bhatt serving as a paid consultant. The findings were presented at the American College of Cardiology’s Annual Scientific Session.

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