More than one in four patients had elevated cortisol.
For decades, millions of Americans have taken armfuls of blood pressure medication and still watched their numbers refuse to fall — a quiet, grinding failure that medicine has struggled to explain. A sweeping new study now suggests that for more than a quarter of these patients, the true culprit was never the heart or the arteries, but a hormone: cortisol, the body's ancient stress messenger, running unchecked and silently undermining every treatment offered. The MOMENTUM study, spanning fifty medical centers and over a thousand patients, invites medicine to reckon with what it has long been trained not to see.
- Nearly ten million Americans remain at serious cardiovascular risk despite taking three or more blood pressure medications, and the standard playbook of dose adjustments and drug combinations has been failing them for years.
- The MOMENTUM study delivered a striking finding: 27% of resistant hypertension patients had elevated cortisol — a rate far higher than medical training has historically led doctors to anticipate.
- Chronically high cortisol doesn't just signal stress — it actively dismantles the body, driving weight gain, muscle loss, and diabetes while chemically blocking the very medications meant to lower blood pressure.
- Compounding the crisis, roughly one in five patients also showed excess aldosterone, and 6% carried both hormonal burdens simultaneously, making standard treatment almost mathematically impossible.
- The path forward is now visible: a simple, inexpensive overnight dexamethasone test could identify hidden hypercortisolism, and researchers are calling for randomized trials of cortisol-lowering therapies to finally break the treatment deadlock.
Nearly ten million Americans take three or more blood pressure medications and still cannot get their numbers under control. For decades, this condition — resistant hypertension — has left both patients and physicians without answers, cycling through dosage changes and drug combinations that lead nowhere.
A large new study suggests the explanation may have been present all along, simply unexamined. Researchers across fifty U.S. medical centers, including Mount Sinai in New York, enrolled over a thousand resistant hypertension patients in a study called MOMENTUM. Using a straightforward overnight test — a dose of dexamethasone followed by a morning blood draw — they measured cortisol levels and found that 27 percent of participants, nearly one in three, had hypercortisolism: the body producing chronically excessive amounts of the stress hormone.
Cortisol in normal quantities is essential, helping regulate inflammation, stress response, and blood sugar. But sustained elevation over months or years causes serious harm — weight gain, muscle loss, increased diabetes risk — and, as this study underscores, appears to actively prevent standard blood pressure medications from working. For patients already facing elevated risk of heart attack and heart failure, this hidden hormonal imbalance may be the missing variable that explains years of failed treatment.
MOMENTUM also revealed that roughly one in five participants had primary hyperaldosteronism, an excess of a separate hormone called aldosterone, and about 6 percent carried both conditions at once — a compounded hormonal burden that would make blood pressure control with conventional drugs nearly impossible.
The implications are significant precisely because the solution appears within reach. The dexamethasone suppression test is simple and inexpensive. Researchers are now calling for randomized clinical trials to determine whether cortisol-lowering therapies can succeed where standard medications have not. If they do, millions of people long trapped in a cycle of treatment failure may finally have a way forward — provided medicine moves quickly enough to act on what this study has uncovered.
Nearly ten million Americans take three or more blood pressure medications and still cannot get their numbers down. Their doctors adjust dosages, add new pills, try different combinations—and nothing works. For decades, this stubborn condition, called resistant hypertension, has frustrated both patients and physicians. A large new study suggests the answer may have been hiding in plain sight: a hormone problem that nobody was looking for.
Researchers at fifty medical centers across the country, including Mount Sinai Health System in New York, enrolled over a thousand patients with resistant hypertension and ran a simple test. They gave participants a dose of dexamethasone at night, drew blood the next morning, and measured cortisol levels. What they found was striking. More than one in four patients—27 percent, or 297 out of 1,086—had elevated cortisol. This is far higher than medical schools have historically taught doctors to expect. The condition is called hypercortisolism, and it means the body is producing too much of what we commonly call the stress hormone.
Cortisol itself is not the enemy. The body needs it to respond to stress, to regulate inflammation, to manage blood sugar. But when cortisol stays elevated over months and years, it becomes a problem. It causes weight gain and muscle loss. It increases the risk of diabetes. And apparently, it can also prevent blood pressure medications from doing their job. For patients already at high risk of heart attack and heart failure—the real dangers of resistant hypertension—this hidden hormonal imbalance could be the missing piece that explains why they cannot get well.
The study, called MOMENTUM, also found that certain patients were more likely to have this problem. Those with reduced kidney function, for instance, were at higher risk. The researchers also discovered that about one in five participants had a related condition called primary hyperaldosteronism, where the body makes too much of a different hormone called aldosterone. A small fraction—roughly 6 percent—had both conditions at once, a double hormonal burden that would make blood pressure control nearly impossible with standard drugs alone.
What makes this discovery potentially transformative is how straightforward the solution could be. The dexamethasone suppression test is simple and inexpensive. Patients are eager for answers. Doctors now have a clear signal to look for something they have been trained to overlook. The next step is obvious: randomized clinical trials to test whether medications that lower cortisol's effects can actually bring blood pressure under control in these patients. If they work, millions of people who have been struggling with uncontrolled hypertension might finally have a path forward. The question now is whether the medical system will act on what this study has revealed.
Notable Quotes
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 in medical school. These findings should prompt more screening for excess levels of cortisol in patients with resistant hypertension.— Dr. Deepak L. Bhatt, MD, MPH, MBA
The Hearth Conversation Another angle on the story
So one in four people with resistant hypertension have this cortisol problem. That seems like a lot. How did doctors miss this for so long?
Because they weren't looking for it. Medical training has historically treated resistant hypertension as a medication problem—adjust the drugs, find the right combination. Nobody was systematically testing for cortisol. It's like looking for your keys under the streetlight instead of where you actually lost them.
But cortisol is the stress hormone, right? Are these patients just stressed?
Not necessarily. Stress can elevate cortisol, sure. But hypercortisolism is a medical condition—the body is producing too much, whether from stress or from a tumor or from something else entirely. The point is that the elevated levels are doing real damage: weight gain, muscle wasting, diabetes, and apparently blocking blood pressure medications from working.
What happens next? Do we have a treatment?
That's the honest answer: we don't know yet. The study found the problem. Now researchers need to run trials to see if cortisol-lowering drugs can actually fix the blood pressure. That takes time. But at least now doctors know to test for it.
And if they do find a treatment that works?
Then ten million Americans with resistant hypertension suddenly have hope. Some of them might finally get their blood pressure under control. Some might avoid heart attacks. That's what's at stake.