This overlooked hormone could be behind high blood pressure that won't go down with pills

People with stubborn high blood pressure are seldom screened for stress hormones, a study has found out.

It is common for people with a persistently high blood pressure to be tested for cholesterol levels, triglycerides and other risk factors. Many of them are prescribed to have multiple tablets with little to no improvement in the readings. 

A study, first of its kind, has found physicians often overlook a hormone problem causing unexplainable spikes in the blood pressure.

About 30 percent of people with resistant hypertension had a hormone disorder caused by high cortisol levels.

Cortisol, a steroid hormone, is released by the adrenal glands and is primarily known as the ‘stress’ hormone, regulating fight or flight responses in the body. It also regulates blood pressure, blood sugar and immune response.

What did the study find?

The US-based study ‘Momentum’ aimed at understanding the connection between high cortisol levels and a resistant blood pressure.

Resistant blood pressure is defined as a hypertension that won’t go away even after taking multiple medicines to lower the reading.

About 1,086 people across 50 centers across the United States were evaluated for levels of cortisol in their bloodstream.

All of them were given a dose of dexamethasone (a synthetic steroid) at night to suppress secretion of cortisol and then blood was drawn next morning to evaluate the changes in the levels.

People having cortisol levels above 1.8ug/dL were said to have hyper cortisolism, with about 297 participants having elevated levels of the stress hormone.

Also, people having reduced kidney function or over production of the hormone aldosterone were more likely to have high levels of cortisol in the bloodstream.

The findings offered a new insight into blood pressure management through regulation of cortisol levels when traditional treatments run ineffective.

Hypertension as a stress disease

As per experts, the emerging observations of a resistant high blood pressure due to stress is very different from what doctors have historically been taught.

For the longest, hypertension was associated with a dysregulated lipid profile and metabolic disturbances. 

Speaking to DH, Dr Rahul Mehrotra, a senior cardiologist at the Artemis Hospital said: “People usually think that high blood pressure is caused by a bad diet or high cholesterol but stress hormones are also a big part of the problem.”

Chronically elevated levels of stress hormones affect the blood vessels and eventually the flow of blood through them.

When cortisol levels remain high for a long time, blood vessels get tighter and less flexible. This makes it harder for the blood to flow, which in turn raises the blood pressure. Cortisol also makes the body hold on to more sodium and water, further causing the spike, said Dr Mehrotra.

The expert said sometimes all other risk factors like cholesterol, blood sugar and others are within limits but the blood pressure readings remain high.

Chronic stress also keeps the body in a fight or flight state which makes the heart rate and pressure on the arteries stay high all the time. This can make it harder to control blood pressure over time, even if lab reports come out normal, added Dr Mehrotra.

High, unmanaged blood pressure is associated with negative cardiovascular outcomes like heart attacks, heart failure and other metabolic disorders.