A major clinical study reveals that excess cortisol is a primary driver of resistant hypertension in over a quarter of patients. The MOMENTUM study evaluated more than 1,000 participants across 50 US centers to quantify the prevalence of this condition. Researchers found that standard blood pressure medications often fail to address underlying hormonal imbalances in these cases.
Key Findings
Resistant hypertension affects nearly 10 million people in the United States and occurs when blood pressure remains high despite treatment with three or more drugs. Clinicians have historically struggled to identify the root cause for these patients who do not respond to conventional therapies effectively. This condition significantly increases the risk of heart attacks, heart failure, and other serious cardiovascular events for sufferers. Management requires a more comprehensive diagnostic approach to ensure patient safety and long-term health stability.
To investigate the issue, scientists conducted the MOMENTUM study, the largest of its kind in the United States to date. Participants underwent a dexamethasone suppression test to measure cortisol levels after taking a specific dose at night before blood draws. The test determined that patients with levels above 1.8 ug/dL had hypercortisolism according to the published protocol.
Out of 1,086 participants, researchers identified 297 cases of hypercortisolism, representing 27 percent of the total group studied. This finding challenges previous medical assumptions regarding the frequency of this hormonal disorder within the resistant population. Another prevalent condition, primary hyperaldosteronism, appeared in about 20 percent of the study population surveyed.
Clinical Implications
"The fact that such a high percentage of patients with resistant hypertension have elevated cortisol levels is very different from what doctors have been historically taught," said Deepak L. Bhatt, MD, MPH, MBA. He serves as a lead researcher and emphasizes the need for broader screening protocols in clinical practice immediately. Medical schools must update curricula to reflect these new statistical realities for future physicians.
Identifying excess cortisol as a contributing factor offers a new pathway for treatment when standard therapies prove ineffective for patients. This approach addresses the root cause rather than simply managing symptoms through additional pharmaceutical interventions. Treating the underlying hormonal issue could potentially lower blood pressure without adding more antihypertensive medications to the regimen. Patients may experience improved quality of life and reduced medication burden as a result of targeted therapy.
Future research will focus on randomized trials to determine if therapies reducing cortisol impact safely treat high blood pressure. Dr. Bhatt noted these trials are the necessary next step to validate the clinical utility of this discovery for public health. The findings are scheduled for presentation at the American College of Cardiology Annual Scientific Session next month.
Study funding came from Corcept Therapeutics Incorporated, and Dr. Bhatt disclosed paid consulting relationships with the sponsor involved. Transparency regarding financial ties remains standard practice in major clinical research disclosures to maintain public trust. These details ensure readers understand the potential conflicts of interest involved in the publication.