The hidden hormone making blood pressure difficult to control

Having high blood pressure can be incredibly frustrating.

You take your medication. You cut back on salt. You try to move more, stress less and eat better. But your numbers don’t seem to budge.

At your last appointment, your numbers are still up — your doctor adjusts your medication, yet again.

After a while, it starts to feel like your body just isn’t cooperating. You can’t help but wonder what you and your doctor could be missing.

Now, new research suggests a hidden hormone problem could be to blame — and it’s something many people (and even some doctors) don’t routinely look for.

Quick answer: Could cortisol be the missing piece?

According to findings from the MOMENTUM study — led by researchers at Mount Sinai and reported in the American Heart Association journal Hypertension—about 27% of people with resistant high blood pressure have elevated cortisol levels, a condition called hypercortisolism.

Cortisol — your body’s main stress hormone — can:

• Raise blood pressure
• Affect how your body handles sodium and fluids
• Make blood pressure medications less effective

Bottom line: If your blood pressure won’t come down despite treatment, a hidden hormone imbalance could be playing a role.

Hormonal highs and blood pressure that won’t budge

The findings come from the MOMENTUM study — the largest U.S.-based analysis so far to examine the connection between cortisol and resistant hypertension.

Resistant hypertension is defined by major medical guidelines as blood pressure that stays above goal despite taking three different medications.

Researchers evaluated 1,086 patients across 50 centers in the United States. Each participant underwent a dexamethasone suppression test, a widely used clinical screening tool that checks whether cortisol levels are being properly regulated.

The results were striking:

• 297 participants had elevated cortisol
• That’s 27% of the group

That’s a significant proportion — and one that surprised experts.

As study leader Dr. Deepak Bhatt, a cardiologist and researcher at Mount Sinai, noted, these findings challenge long-held assumptions and suggest more patients with resistant hypertension may benefit from hormone screening.

Why cortisol can quietly drive your numbers higher

Cortisol plays an essential role in your body. It helps regulate stress, metabolism, inflammation and blood pressure.

But when levels stay elevated over time, it can start to work against you.

Research shows chronically high cortisol may:

• Constrict blood vessels
• Increase sodium and fluid retention
• Disrupt other hormone systems
• Reduce the effectiveness of blood pressure medications

In other words, you may be treating high blood pressure without addressing what’s contributing to it.

Why this matters

According to estimates from the American Heart Association, millions of Americans live with resistant hypertension, putting them at higher risk for heart attack, stroke and other cardiovascular complications.

This research helps explain why some of those cases remain difficult to manage — even when patients follow treatment plans closely.

It also reflects a broader shift in medicine toward identifying underlying drivers of disease, rather than focusing only on symptoms.

While more clinical trials are needed to determine how best to treat cortisol-related hypertension, experts say increased awareness and screening could be an important step forward.

What you can do if your blood pressure stays high

If your blood pressure isn’t responding to treatment, here are realistic next steps to consider:

Talk to your doctor about testing

Ask whether screening for elevated cortisol makes sense in your case — particularly if you’re already taking multiple medications.

Make sleep a priority

Sleep plays a direct role in hormone regulation. Research shows that poor sleep can increase cortisol levels, so aim for 7–9 hours per night.

Keep movement consistent

Moderate physical activity — like walking, swimming or cycling — has been shown to help regulate stress hormones over time.

Eat to support hormone balance

A diet rich in whole foods, fiber and healthy fats, like the Mediterranean diet, can support metabolic and hormonal health, while ultra-processed foods and excess sugar may work against it.

Consider calming nutrients

L-theanine, an amino acid found in tea, has been studied for its potential to reduce stress and support healthier cortisol levels.

The bottom line

The takeaway? Sometimes the issue isn’t what you’re doing — it’s what hasn’t been checked yet. Here’s what to keep in mind:

• About 1 in 4 people with resistant high blood pressure may have elevated cortisol
• This stress hormone can interfere with blood pressure control and medication effectiveness
• Screening may help uncover hidden causes in difficult cases
• Addressing underlying imbalances could improve long-term heart health

Sources:
This overlooked hormone could be why your blood pressure won’t drop — ScienceDaily

Nearly 30 Percent of Patients With Resistant Hypertension Have a Hormone Disorder Caused by High Cortisol — Mount Sinai

Resistant Hypertension: Detection, Evaluation, and Management — American Heart Association