The MOMENTUM study found that 27% of patients with resistant hypertension had hypercortisolism. This finding is important because it shows that excess cortisol is much more common in these patients than researchers and clinicians previously thought.
Resistant hypertension occurs when blood pressure remains high even after taking three or more medications. Approximately 10 million people in the United States have this condition. Researchers are increasingly recognizing that underlying health problems can interfere with the effectiveness of standard treatments.
One of those problems is hypercortisolism, a condition in which the body produces too much cortisol. Cortisol, also known as the “stress hormone,” helps regulate the body’s response to stress. However, if cortisol levels remain elevated for long periods of time, they can cause serious health problems.
Why this discovery is important for heart health
Patients with resistant hypertension are at increased risk of serious cardiovascular events such as heart attack and heart failure. At the same time, hypercortisolism is associated with complications such as weight gain, muscle loss, and diabetes.
Identifying excess cortisol as a contributing factor may help explain why some patients have trouble controlling blood pressure. Treating hypercortisolism also opens up the possibility of providing new ways to lower blood pressure when standard treatments are ineffective.
Largest study of its kind in the US
MOMENTUM is the first study conducted in the United States and the largest study to date to measure how common hypercortisolism is among patients with resistant hypertension.
Researchers evaluated 1,086 participants at 50 centers across the country, including New York’s Mount Sinai Health System. After confirming eligibility, participants underwent a dexamethasone suppression test. This involved taking dexamethasone in the evening and having blood drawn the next morning to measure cortisol levels. Patients with cortisol levels >1.8 ug/dL were classified as having hypercortisolism.
Study results and additional risk factors
Of the 1,086 participants, 297, or 27 percent of the group, were found to have hypercortisolism.
The study also identified factors that increase the likelihood of developing this condition. For example, patients with decreased kidney function are more likely to have elevated cortisol levels.
Another condition associated with resistant hypertension is “primary hyperaldosteronism,” which occurs when the body produces too much aldosterone. Approximately 20 percent of participants had this disorder, and approximately 6 percent had both hypercortisolism and hyperaldosteronism.
What should patients and doctors do next?
The findings suggest that physicians should consider elevated cortisol as a possible cause of resistant hypertension and screen high-risk patients. The test is relatively simple, and many patients want to know why they have difficulty controlling their blood pressure.
Patients whose blood pressure remains high despite taking multiple medications may benefit from asking their doctor about screening for hypercortisolism.
Expert perspective
“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 Deepak L. Bhatt, MD, MPH, MBA. “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 and presentations
Research Funding: Corcept Therapeutics Incorporated served as the research sponsor and provided funding for the study. Dr. Butt is a paid consultant for Corcept Therapeutics Incorporated.
Conference: American College of Cardiology Annual Scientific Sessions
