Research details: “Prevalence and clinical impact of hypercortisolism in patients with resistant hypertension: key findings from the MOMENTUM study”
meeting: American College of Cardiology Scientific Sessions 2026 – Featured Clinical Research Presentations
Presenter/Principal Investigator: Deepak L. Bhatt, MD, MPH, MBA, Valentin Faster Professor of Cardiology, Icahn School of Medicine at Mount Sinai and Director, Mount Sinai Faster Heart Hospital
Conclusion: The MOMENTUM study found that 27% of patients with resistant hypertension had hypercortisolism. This is an important finding, indicating that hypercortisolism is more common in these patients than researchers and clinicians previously understood.
Resistant hypertension is a condition in which blood pressure remains high despite a patient taking three or more different antihypertensive drugs. This affects approximately 10 million people with high blood pressure across the United States. We are now beginning to understand that these patients may have other underlying conditions that make their blood pressure resistant to conventional treatment. One of these symptoms is hypercortisolism, which occurs when your body produces too much of the hormone cortisol. This hormone is commonly known as the “stress hormone” because it helps the body respond to stress, but cortisol itself can be a serious problem if it’s consistently high.
Why research is important: Resistant hypertension puts patients at increased risk of cardiovascular complications such as heart attack and heart failure. Hypercortisolism can also lead to a wide range of problems, including weight gain, muscle loss, and diabetes. This discovery may help patients with hypercortisolism learn why their blood pressure is resistant to treatment, and treating the underlying hypercortisolism may provide clinicians and patients with new options for lowering blood pressure that is resistant to conventional treatments.
Why this study is unique:MOMENTUM is the first US-based study and the largest study to date to determine what percentage of patients with resistant hypertension have hypercortisolism.
How the study was conducted: Researchers analyzed 1,086 participants from 50 centers across the country, including New York’s Mount Sinai Health System. After confirming that they met the criteria for study participation, patients underwent a dexamethasone suppression test, which consisted of taking a dexamethasone pill before bed and taking a blood test the next morning to measure cortisol levels. Cortisol levels above 1.8 ug/dL were considered to have hypercortisolism.
result: 297 of 1,086 participants (27%) had hypercortisolism.
Researchers also identified characteristics that predispose people to hypercortisolism, such as medications and other medical conditions. For example, we found that patients with decreased kidney function were more likely to have hypercortisolism.
Another condition that can contribute to resistant hypertension is called “primary hyperaldosteronism,” where the body produces too much of the hormone aldosterone. The study found that approximately 20% of participants had this condition. Approximately 6 percent of participants had both hypercortisolism and hyperaldosteronism.
What this research means for clinicians and patients: Physicians should consider elevated cortisol as a contributor to resistant hypertension and should screen high-risk patients. Screening is not difficult, and patients are generally willing to undergo tests that explain why their blood pressure is difficult to control. From a public education perspective, if patients are taking multiple medications and have difficulty controlling their blood pressure, they should be encouraged to get tested for hypercortisolism.
Quote: Deepak L. Bhatt, MD, MPH, MBA
“The fact that such a high proportion (more than 25%) of patients with resistant hypertension have elevated cortisol levels is very different from what physicians have historically been taught in medical school. These findings should further encourage screening for excessive levels of cortisol in patients with resistant hypertension,” says Dr. Butt. “The next step to advance this research is to conduct a randomized trial to determine whether treatments that reduce the effects of cortisol can safely and effectively treat hypertension in these patients.”
Research funding: Corcept Therapeutics Incorporated served as the study sponsor and provided funding for the study. *Dr. Bhatt is a paid consultant for Corcept Therapeutics Incorporated.
sauce:
Mount Sinai Health System
