High cortisol linked to 27% of difficult-to-treat high blood pressure cases
Study: Hypercortisolism is a hallmark of Cushing's syndrome
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Elevated levels of cortisol, or hypercortisolism, a hallmark of Cushing’s syndrome, are present in over a quarter of people with treatment-resistant high blood pressure (hypertension), according to a study.
Results come from the MOMENTUM observational trial (NCT06829537), which enrolled more than 1,080 adults with uncontrolled hypertension despite the use of at least three different types of medications to lower blood pressure. The trial was sponsored by Corcept Therapeutics, which markets Korlym (mifepristone) and is developing relacorilant for the treatment of Cushing’s.
The results were presented at the American College of Cardiology Annual Scientific Session, held March 28-30 in New Orleans.
“Resistant hypertension increases the risk of cardiovascular events like heart attacks, strokes, and heart failure, as well as kidney damage,” Deepak L. Bhatt, MD, professor at the Icahn School of Medicine at Mount Sinai and lead investigator of the study, said in a company press release. “MOMENTUM shows that hypercortisolism contributes to resistant hypertension … and that screening for hypercortisolism in these challenging-to-treat patients may help physicians provide more personalized care.”
Common complications of Cushing’s include hypertension, diabetes
Cushing’s syndrome refers to conditions in which symptoms are driven by excessive production of cortisol. Cushing’s disease is a form of the syndrome caused by tumors in the brain’s pituitary gland.
Common complications of Cushing’s include hypertension and diabetes, which may be hard to treat with conventional therapies that don’t address the underlying cause of excessive cortisol.
The MOMENTUM trial was a non-interventional study to assess the prevalence of endogenous hypercortisolism in adults with resistant hypertension at 45 sites in the U.S. Among a total of 1,086 patients with resistant hypertension, 297 patients (27.3%) had hypercortisolism. Hypercortisolism was detected using the 1mg dexamethasone suppression test, commonly used to diagnose Cushing’s.
Resistant hypertension was defined as blood pressure of 130 mmHg or higher during heart contraction (systolic blood pressure), despite using three or more antihypertensive medications from different classes, including a diuretic, or the need for four or more antihypertensive medications to control blood pressure. Diuretics are medications that increase urine production, which may help manage blood pressure.
Patients with hypercortisolism had poorer kidney function
Participants with hypercortisolism had lower body mass index and waist circumference than those without hypercortisolism. BMI is a measure of body fat based on height and weight.
The use of antihypertensive medications was similar in both groups of patients; however, in patients with hypercortisolism, there was a trend to use certain medications more frequently to treat diabetes.
Additionally, those with hypercortisolism had poorer kidney function and numerically more cardiac diseases, including heart failure.
The prevalence of hypercortisolism was over 30% in patients with cardiac disorders or diabetes and over 40% in patients with chronic kidney disease.
Among all participants with resistant hypertension, about 20% had higher levels of aldosterone, a hormone that regulates blood pressure and fluid balance, including about 6% with both elevated cortisol and aldosterone.
“It is now clear that hypercortisolism is more common than previously assumed in patients whose hypertension and diabetes don’t respond to standard-of-care treatments.
These findings complement the results of the Phase 4 CATALYST trial (NCT05772169), which demonstrated that 23.8% of 1,057 participants with hard-to-treat type 2 diabetes had Cushing’s syndrome. Hard-to-treat type 2 diabetes was defined as having a hemoglobin A1c (HbA1c) level of 7.5% or higher despite standard treatment. HbA1c reflects the average blood sugar level over the past two to three months by measuring how much sugar is attached to hemoglobin, the protein in red blood cells that carries oxygen.
The prevalence of hypercortisolism in patients with HbA1c of 7.5% or higher who were taking three or more medications to lower blood pressure was 32.6% in the MOMENTUM study and 36.6% in the CATALYST trial.
“It is now clear that hypercortisolism is more common than previously assumed in patients whose hypertension and diabetes don’t respond to standard-of-care treatments,” said Bill Guyer, Corcept’s chief development officer. “We are grateful to the investigators and patients who have participated in this research and hope that the findings will provide critical information to support increased screening for hypercortisolism, more accurate diagnoses, and improved treatment options.”
