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Adrenal (Excluding Mineralocorticoids)

MON-515 - Characterization of Individuals With Resistant Hypertension and Post–Dexamethasone Suppression Test Cortisol <1.2, 1.2–1.8, and >1.8 µg/dL: Results From the MOMENTUM Study

Monday, June 15, 2026
9:00 AM - 2:00 PM CT


Introduction: Resistant hypertension (rHTN) confers a high risk of cardiovascular disease. Recognition of treatable secondary endocrine contributors, such as endogenous hypercortisolism (HC), is growing. The CATALYST study (NCT05772169) included 1,057 individuals in the US with difficult-to-control type 2 diabetes (T2D). CATALYST found an HC prevalence of 24% and incrementally greater medication use and disease burden as post–dexamethasone suppression test (DST) cortisol increased from < 1.2 μg/dL to 1.2–1.8 μg/dL to >1.8 μg/dL. The MOMENTUM study (NCT06829537) used the DST to assess the prevalence of HC in a US cohort with rHTN. Here, we report the frequency and clinical characteristics of participants stratified by post-DST cortisol levels < 1.2 μg/dL, 1.2–1.8 μg/dL, and >1.8 μg/dL.

Methods: MOMENTUM was a prospective, observational study that screened 1,086 adults (≥18 years) with rHTN for HC. rHTN was defined as systolic blood pressure (SBP) ≥130 mmHg despite taking ≥3 antihypertensives from different classes (including a diuretic) or ≥4 antihypertensives from different classes regardless of SBP. HC was defined as post–1 mg overnight DST cortisol >1.8 µg/dL with dexamethasone levels ≥140 ng/dL in a population that excluded participants with conditions that could confound DST interpretation. Descriptive statistics were used to summarize participant characteristics.

Results: HC prevalence was 27%. Post-DST cortisol was < 1.2 µg/dL in 42% and 1.2–1.8 µg/dL in 30% of participants. The prevalence of cardio-renal-metabolic conditions trended higher in the groups with increased post-DST cortisol: coronary artery disease (8% [ < 1.2 μg/dL], 11% [1.2-1.8 µg/dL], 13% [>1.8 µg/dL]), atrial fibrillation (8%, 11%, 11%), T2D (40%, 53%, 49%), and chronic kidney disease (11%, 19%, 18%). A similar trend was seen for use of ≥10 medications (34%, 43%, 40%), ≥4 antihypertensive medications (53%, 59%, 60%), any antihyperglycemic medication (43%, 55%, 54%), insulin (12%, 19%, 23%), metformin (26%, 28%, 30%), glucagon-like peptide-1 receptor agonists including tirzepatide (16%, 22%, 19%), and sodium-glucose cotransporter 2 inhibitors (12%, 21%, 23%). Renal function decreased across increasing post-DST cortisol groups (median estimated glomerular filtration rate: 76, 69, and 62 mL/min/1.73 m2; median urine albumin-to-creatinine ratio: 10, 16, and 22 g/kg).

Conclusions: MOMENTUM, the largest screening study for HC to date in persons with rHTN, found a prevalence of HC of 27%, far higher than previously considered. Numerical increases in cardiac comorbidities, medication burden, and renal dysfunction between the < 1.2 µg/dL and >1.2 µg/dL groups indicate a spectrum of cardio-renal-metabolic complications associated with chronic cortisol excess below the conventional diagnostic cutoff of 1.8 µg/dL. These findings underscore the importance of screening this population to identify HC.

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