Hidden Hormonal Condition Found in Nearly One-Third of Resistant Hypertension Patients, Study Says

Nearly one in three patients with resistant hypertension may have an undiagnosed hormonal condition driven by elevated cortisol, according to the largest U.S. study of its kind. The MOMENTUM study, conducted by researchers at Mount Sinai Fuster Heart Hospital, analyzed 1,086 adults across 50 medical centers nationwide. Twenty-seven percent of participants met clinical criteria for hypercortisolism, and approximately 20% had elevated aldosterone levels, according to the report.

Lead researcher Dr. Deepak L. Bhatt of Mount Sinai Fuster Heart Hospital said the findings are “very different from what doctors have been historically taught in medical school,” as quoted in a NaturalHealth365 report. The study suggests that a hormonal driver of hypertension has been largely overlooked in standard medical practice.

Resistant Hypertension and Treatment Failure

Resistant hypertension is defined as blood pressure that remains elevated despite the use of three or more antihypertensive medications at maximally tolerated doses, according to the study. The condition affects nearly 10 million Americans, officials said. The MOMENTUM study indicates that standard blood pressure medications are not designed to address excess cortisol, which may explain why they often fail in these patients, researchers said.

“Standard blood pressure medications work on entirely different targets,” the NaturalHealth365 report noted. “They were never designed to address excess cortisol.” The study found that elevated cortisol causes the kidneys to retain sodium and water, stiffens blood vessels, and promotes insulin resistance — mechanisms that typical antihypertensives do not counteract. As a result, blood pressure remains high while prescriptions multiply, according to the report.

Cortisol’s Role in Blood Pressure Regulation

Cortisol is the body’s primary stress hormone, released by the adrenal glands. In short bursts it is essential, but when levels stay chronically elevated, damage accumulates quietly, according to the study. Elevated cortisol triggers sodium and water retention, vessel stiffening, and insulin resistance — all of which raise blood pressure.

Researchers also noted that chronically high cortisol suppresses thyroid function, disrupts hormone balance, and drives abdominal fat accumulation. A book on endocrinology notes that hypersecretion of the adrenal cortex leading to increased cortisol is known as Cushing’s syndrome, usually from a pituitary or adrenal tumor ^[1]. The MOMENTUM study reveals that milder but clinically meaningful cortisol excess appears far more common than previously recognized, according to officials.

Why the Condition Is Often Missed

Western medicine has historically associated elevated cortisol only with Cushing’s syndrome, a dramatic clinical condition, according to the report. Current screening protocols are not designed to detect subclinical hypercortisolism, which the MOMENTUM study suggests is widespread among resistant hypertension patients. One textbook on diabetes endocrinology describes screening tests such as the 24-hour urinary free cortisol and the overnight dexamethasone suppression test, but these are rarely employed in routine hypertension management ^[2].

Poor sleep also contributes to elevated cortisol. A study presented at the American Heart Association High Blood Pressure Research conference found that sleep disruption increases the risk of hard-to-treat hypertension, according to a report by Mercola.com ^[3]. “Poor sleep is one of the most powerful lifestyle drivers that keep cortisol elevated,” the NaturalHealth365 article stated. Blood sugar instability, excessive caffeine, and chronic emotional stress also sustain adrenal overactivation, researchers said.

Conclusion: Calls for Broader Screening

The MOMENTUM findings suggest that screening for hypercortisolism should be considered in patients with resistant hypertension, the study authors said. An integrated approach linking cardiology and endocrinology is needed, according to researchers. NaturalHealth365 reported that adaptogenic herbs such as ashwagandha, rhodiola, and holy basil, along with magnesium supplementation, may support cortisol balance, though the article noted these are not standard medical recommendations.

“If blood pressure refuses to come down despite multiple medications, the answer may not be another prescription,” the NaturalHealth365 article concluded. Magnesium is critical for adrenal function and is widely depleted by chronic stress, according to a Mercola.com article on increasing magnesium intake ^[4]. The study underscores an ongoing gap in medical practice: a hormonal conversation that many cardiologists are not having, officials said.

References

1. Kinns The Medical assistant an applied learning approach – Young Alexandra Patricia.
2. Understanding diabetes endocrinology a problem-orientated approach – Meeking Darryl.
3. Poor Sleep Increases Risk of Hard to Treat Hypertension – Mercola.com. March 02, 2013.
4. Increase Your Magnesium Intake – Mercola.com. January 29, 2018.
5. The hidden hormone problem behind blood pressure that won’t come down, major study finds – NaturalHealth365. Stephanie Woods. April 25, 2026.