Key result
In resistant hypertension, eGFR <45 is linked to ~85% higher prevalence of endogenous hypercortisolism.
Why the study?
The relationship between chronic kidney disease and endogenous hypercortisolism in individuals with resistant hypertension is not well characterized.
What is the prevalence of endogenous hypercortisolism in individuals with resistant hypertension stratified by kidney function?
Observational (n=1,086)
What is the prevalence of endogenous hypercortisolism in individuals with resistant hypertension stratified by kidney function?
Absolute Event Rate: 43.6% vs 23.6%
p-value: p=<0.0001
Individuals with resistant hypertension and reduced kidney function have a significantly higher prevalence of endogenous hypercortisolism, suggesting a need for targeted screening in this high-risk population.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Everybody's been told for decades now that hyperaldosteronism is common, and we're under diagnosing and undertreating it. But nobody is hearing that hypercortisolism is also common in resistant hypertension. People know it's a cause, but they think it's rare. Part of the reason for that is the old way of diagnosing was to look at the patient and decide if they look like they have Cushing's syndrome, and if they don't look like they have it, don't work it up. We now know that while severe hypercortisolism is uncommon, mild is not so uncommon and is treatable. So we need to consider hypercortisolism when people with hypertension or diabetes don't respond to medicines the way we expect them to.”
“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. 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.”
“When they're on multiple medications and you're not seeing the kind of blood pressure control you normally would see, maybe you should be looking for a secondary cause. Hyperaldosteronism is one, but we're seeing just as much hypercortisolism.”
May support hypercortisolism screening consideration in resistant hypertension with eGFR <45; leaves open causal and therapeutic implications.
Background MOMENTUM (NCT06829537), the first US-based trial assessing endogenous hypercortisolism (HC) in individuals with resistant hypertension (rHTN), found an HC prevalence of 27.3%. Chronic kidney disease (CKD) is a cause and consequence of rHTN; however, the relationship between CKD and HC is not well characterized in rHTN. We performed an analysis of participants in MOMENTUM by renal function to evaluate this relationship. Methods MOMENTUM was an observational study that screened adults with rHTN (per American Heart Association criteria) using the 1-mg overnight dexamethasone suppression test (DST; HC=post-DST cortisol >1.8 μg/dL). Individuals with conditions that could confound DST interpretation were excluded. Historical estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 was exclusionary, but eGFR assessed at baseline was used for this analysis. The eGFR subgroups analyzed were <45, 45-59, and ≥60 mL/min/1.73 m2. Results Of the 1,086 MOMENTUM participants, 140 (12.9%), 203 (18.7%), and 743 (68.4%) had an eGFR <45, 45-59, ≥60 mL/min/1.73 m2, respectively, and the HC prevalence in these subgroups was 43.6%, 30.0%, and 23.6%, respectively. In participants with HC, mean eGFR was lower (P<0.0001) and mean urine albumin-to-creatinine ratio trended higher (P=0.097) compared to those without HC. Similarly, the frequency of HC was higher in the lower eGFR subgroups and higher CKD progression risk categories (P<0.0001 for any difference across groups). Conclusion MOMENTUM showed that individuals with rHTN and reduced kidney function have an elevated risk of HC, supporting the need for targeted screening in this high-risk population. Is this an encore abstract? No
No takes yet. Share an insight, caveat, or question.
DeFronzo et al. (2026) conducted an observational in Resistant hypertension (n=1,086). Reduced kidney function (eGFR <45 mL/min/1.73 m2) vs. eGFR ≥60 mL/min/1.73 m2 was evaluated on Prevalence of endogenous hypercortisolism (p=<0.0001). Among adults with resistant hypertension, reduced kidney function (eGFR <45 mL/min/1.73 m2) was associated with a higher prevalence of endogenous hypercortisolism compared to eGFR ≥60 (43.6% vs 23.6%, P<0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: