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How Common Is Hypercortisolism in Patients With Hypertension? Risk Factors, Epidemiology, and Making a Diagnosis
Omar Al Dhaybi1,2, Deepak L Bhatt1,2
1AHA Comprehensive Hypertension Center, Mount Sinai Fuster Heart Hospital, New York, New York, USA.
Diabetes, Obesity & Metabolism
|July 15, 2026
Summary
Endogenous hypercortisolism (EHC), a form of cortisol excess, is a significant cause of hypertension, especially resistant hypertension. Screening for EHC in hypertensive patients may improve outcomes.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Endogenous hypercortisolism (EHC) is increasingly recognized as a key factor in hypertension development and progression.
- Previously considered rare, EHC is now understood as a spectrum of cortisol excess linked to adverse cardiometabolic effects and target-organ damage.
Purpose of the Study:
- To review recent epidemiological data on EHC in hypertension.
- To discuss diagnostic approaches for EHC.
- To emphasize the importance of systematic screening for EHC in resistant hypertension.
Main Methods:
- Literature review of large-scale epidemiological studies.
- Synthesis of data on EHC prevalence in hypertensive populations.
- Discussion of diagnostic modalities for cortisol excess.
Main Results:
- EHC is more prevalent in patients with resistant hypertension and poorly controlled diabetes than previously thought.
- Classic Cushingoid features are often absent in these patients.
- Systematic screening for EHC is warranted in specific patient groups.
Conclusions:
- EHC is an underdiagnosed contributor to resistant hypertension.
- Early identification and management of EHC can potentially improve cardiovascular and metabolic outcomes.
- Further research and clinical guidelines are needed to facilitate EHC screening.
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