The MOMENTUM Study: Excess Cortisol Identified in 27% of Patients with Treatment-Resistant Hypertension

The MOMENTUM study finds that over a quarter of people with resistant hypertension have excess cortisol, suggesting a new path for treatment-resistant patients.

By: AXL Media

Published: Mar 30, 2026, 11:18 AM EDT

Source: Information for this report was sourced from The Mount Sinai Hospital / Mount Sinai School of Medicine

Redefining the Causes of Stubborn Hypertension

Resistant hypertension is a significant public health challenge, affecting nearly 10 million people in the United States who cannot achieve healthy blood pressure levels despite taking three or more medications. For decades, clinicians have struggled to identify why these patients remain at high risk for heart failure and stroke. However, data from the MOMENTUM study suggests that the culprit may not be the cardiovascular system alone, but a hidden endocrine imbalance. Researchers discovered that 27% of participants had hypercortisolism—a much higher prevalence than the rare "Cushing's syndrome" scenarios typically taught in medical schools.

The Physiological Link Between Cortisol and Blood Pressure

Cortisol is widely known as the "stress hormone," essential for the body’s "fight or flight" response. While temporary spikes are natural, chronically elevated cortisol levels can lead to systemic damage, including weight gain, muscle loss, and diabetes. In the context of hypertension, excess cortisol can interfere with the body's ability to regulate fluid and arterial tension, effectively neutralizing the benefits of standard antihypertensive drugs. The MOMENTUM study evaluated 1,086 participants across 50 centers, using a dexamethasone suppression test to confirm that more than 25% of these "resistant" cases were actually hormonal in nature.

Identifying Dual Hormonal Risks and Kidney Factors

The study also highlighted the complexity of resistant hypertension by identifying co-occurring hormonal disorders. Approximately 20% of the participants suffered from primary hyperaldosteronism—excessive production of the salt-retaining hormone aldosterone—while 6% of the total group struggled with both elevated cortisol and aldosterone. Furthermore, researchers noted that patients with reduced kidney function were statistically more likely to exhibit hypercortisolism. This interconnected web of renal and endocrine health suggests that a siloed approach to treating "just the heart" is often insufficient for long-term recovery.