Prevalence of Hypercortisolism in Resistant Hypertension

In ‘Prevalence of Hypercortisolism in Resistant Hypertension,’ our panel explores the growing recognition of hypercortisolism as an important contributor to resistant hypertension, cardiovascular disease, and cardiometabolic dysfunction. Expert cardiology faculty discuss the significant burden of cardiovascular complications associated with cortisol excess and examine why patients with hypercortisolism often experience difficult-to-control hypertension, diabetes, and other metabolic abnormalities.

The panel reviews emerging evidence demonstrating the high prevalence of hypercortisolism among patients with resistant hypertension and highlights findings suggesting that the condition may be substantially more common than previously appreciated. They discuss the relationship between cortisol excess and cardiovascular risk, including its effects on blood pressure regulation, metabolic health, and long-term outcomes. The faculty also consider how hypercortisolism may contribute to persistent cardiovascular risk even when traditional comorbidities such as hypertension and diabetes are treated.

Throughout the discussion, the panelists emphasize the potential benefits of identifying underlying hypercortisolism in patients with resistant hypertension. They explore how establishing an accurate diagnosis may help clinicians move beyond empiric treatment strategies and toward more targeted approaches that address the root cause of disease. The panel also highlights the possibility of disease modification or reversal in select patients and discusses how earlier recognition may improve cardiovascular and metabolic outcomes. By examining prevalence data, cardiovascular consequences, and opportunities for intervention, the panel provides practical insights into why hypercortisolism should be considered when evaluating patients with resistant hypertension and other cardiometabolic conditions.

Our next episode, ‘Recognizing Hypercortisolism in Cardiovascular Practice,’ features the panelists discussing patient characteristics, clinical presentations, and hypertension phenotypes that may suggest underlying hypercortisolism. They highlight practical clues that can help cardiologists identify patients who may benefit from further evaluation, even in the absence of classic features of Cushing syndrome.