The Role of Hypercortisolism in Resistant Hypertension

In this episode, ‘The Role of Hypercortisolism in Resistant Hypertension,’ the panelists, expert primary care physicians, explore findings from the MOMENTUM study and discuss how they expand awareness of hypercortisolism beyond patients with difficult-to-control type 2 diabetes. The panel reviews the study design, including the definition of resistant hypertension, eligibility criteria, and use of the overnight dexamethasone suppression test to identify endogenous hypercortisolism.

The discussion highlights the unexpectedly high prevalence of hypercortisolism among patients with resistant hypertension and examines the associated burden of cardiovascular disease, kidney dysfunction, and diabetes observed within the study population. The panelists compare the MOMENTUM findings with those from the CATALYST trial, emphasizing the consistency of the results and how both studies reinforce the need to consider hypercortisolism in patients with persistent cardiometabolic disease despite appropriate medical therapy.

The panel also discusses how these data can be translated into primary care practice. Rather than advocating broad population screening, they emphasize identifying patients whose hypertension remains difficult to control despite adherence to multiple antihypertensive medications. Throughout the conversation, expert faculty encourage clinicians to move beyond routine treatment escalation and instead consider whether an underlying endocrine disorder may be contributing to persistent hypertension or metabolic dysfunction. By integrating emerging evidence with real-world clinical experience, the panel provides practical insights into recognizing patients who may benefit from targeted screening and timely referral, with the goal of reducing diagnostic delays and improving long-term cardiovascular and metabolic outcomes.

The next episode in this series, ‘Hypercortisolism Recognition and Referral in Primary Care,’ features the panelists discussing how primary care clinicians can recognize suspected hypercortisolism, determine appropriate next diagnostic steps, and partner effectively with endocrinologists to ensure timely evaluation and management. The panel also discusses the importance of clinical advocacy when suspicion remains high despite inconclusive initial assessments.