Study Details: “Prevalence and Clinical Impact of Hypercortisolism in Individuals with Resistant Hypertension: Primary Results from the MOMENTUM Study”
Conference: American College of Cardiology Scientific Session 2026 – Featured Clinical Research Presentation
Presenter/Lead Investigator: Deepak L. Bhatt, MD, MPH, MBA, Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai and Director of Mount Sinai Fuster Heart Hospital
Bottom Line: The MOMENTUM study found 27 percent of patients with resistant hypertension have hypercortisolism. This is a significant finding, demonstrating that hypercortisolism is more common in these patients than previously understood by researchers and clinicians.
Resistant hypertension is a condition where blood pressure stays high even though patients take three or more different blood pressure medications. This impacts nearly 10 million patients with high blood pressure across the United States. We are now beginning to understand that these patients may have other underlying medical conditions that make their blood pressure resistant to conventional treatments. One of these conditions is hypercortisolism, which happens when the body makes too much of the hormone cortisol. This hormone is commonly known as the “stress hormone,” since it helps the body respond to stress, but cortisol itself becomes a serious problem if it’s high all the time.
Why the study is important: Resistant hypertension puts patients at high risk of cardiovascular complications such as heart attack and heart failure. Hypercortisolism may also lead to a wide range of additional problems including weight gain, muscle loss, and diabetes. This finding will let patients with hypercortisolism know the reason their blood pressure is resistant to treatment, and treating the underlying hypercortisolism may also provide a new option for clinicians and patients to lower blood pressure that is resistant to conventional treatments.
Why this study is unique: “ MOMENTUM” is the first United States-based study and 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 across 50 centers across the United States, including Mount Sinai Health System in New York. After confirming that they met the criteria for study participation, patients were given a dexamethasone suppression test, which consisted of taking a tablet of dexamethasone before bedtime and getting a blood test to measure their cortisol level the next morning. If their cortisol level was greater than 1.8 ug/dL, they were considered to have hypercortisolism.
Results: 297 of the 1,086 participants had hypercortisolism, or 27 percent.
Researchers also identified the characteristics, such as medications and other medical conditions, that make it more likely for someone to have hypercortisolism. For example, they found patients with poor kidney function are more likely to have hypercortisolism.
Another disease that may contribute to resistant hypertension is called “primary hyperaldosteronism,” where the body makes too much of the hormone aldosterone. The study found that approximately 20 percent of participants had this condition. About 6 percent of participants had both hypercortisolism and hyperaldosteronism.
What this study means for clinicians and patients: Physicians need to consider elevated cortisol as a contributor to resistant hypertension and should screen their high-risk patients. Screening is not difficult, and patients generally are motivated to have a test that explains why they are having trouble controlling their blood pressure. In terms of public education, if patients have blood pressure that is difficult to control despite multiple medications, they should push to get screened for hypercortisolism.
Quotes: Deepak L. Bhatt, MD, MPH, MBA
“The fact that such a high percentage (more than 25 percent) of patients with resistant hypertension have elevated cortisol levels is very different from what doctors have been historically taught in medical school. These findings should prompt more screening for excess levels of cortisol in patients with resistant hypertension” says Dr. Bhatt. “The next step to further this research is conducting randomized trials to determine if therapies that lower the impact of cortisol can safely and effectively treat high blood pressure in these patients.”
Study Funding: Corcept Therapeutics Incorporated was the study sponsor and funded the study. *Dr. Bhatt is a paid consultant for Corcept Therapeutics Incorporated.
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