Martha Gulati, MD, MS, FACC, FAHA

Hypercortisolism as a Driver of Hypertension and Cardiovascular Risk

In this episode, ‘Hypercortisolism as a Driver of Hypertension and Cardiovascular Risk,’ the panelists explore the evolving understanding of hypercortisolism as an underrecognized contributor to hypertension, cardiovascular disease, and cardiometabolic risk. Expert cardiology faculty discuss how traditional teaching has focused on the classic physical manifestations of Cushing syndrome, while emerging evidence suggests that many patients with clinically significant cortisol excess may not present with these recognizable features.

The panel examines how this shift in understanding has influenced clinical practice and highlights the importance of looking beyond phenotypic signs when evaluating patients with resistant hypertension and unexplained cardiovascular risk. They discuss the growing body of evidence linking cortisol excess to adverse cardiovascular outcomes and consider how hypercortisolism may contribute to disease progression through mechanisms that extend beyond elevated blood pressure alone.

Throughout the conversation, the panel of experts reflects on the overlap between hypercortisolism and other endocrine drivers of cardiovascular disease, including the role of mineralocorticoid receptor activation and its potential implications for hypertension management. The faculty also explore why cortisol-mediated hypertension may carry additional cardiovascular risk and discuss data suggesting that addressing comorbidities alone may not fully mitigate the consequences of cortisol excess.

By examining emerging concepts in the recognition and clinical significance of hypercortisolism, the panel provides practical insights into why cardiologists should consider cortisol excess when evaluating patients with difficult-to-control hypertension and other cardiometabolic conditions. The discussion highlights the importance of increased awareness and earlier identification as the field continues to evolve.

The next episode in this series, ‘Prevalence of Hypercortisolism in Resistant Hypertension,’ features the panelists discussing the prevalence and cardiovascular consequences of hypercortisolism in patients with resistant hypertension and cardiometabolic disease. They highlight the potential benefits of earlier recognition and targeted intervention to improve long-term cardiovascular and metabolic outcomes.

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In, ‘Hypercortisolism as a Driver of Hypertension and Cardiovascular Risk’, panelists will continue their discussion on hypercortisolism and highlight how cortisol excess can contribute to hypertension and cardiovascular risk even in the absence of classic Cushing syndrome features. They also explore emerging evidence linking hypercortisolism to adverse cardiometabolic outcomes and the implications for cardiovascular practice.

The Challenge of Resistant Hypertension

Welcome back to another HCP Live Peer Exchange series. In this episode titled, ‘The Challenge of Resistant Hypertension,’ expert faculty discuss the persistent burden of uncontrolled and resistant hypertension despite significant advances in cardiovascular care. The panel explores common barriers to achieving blood pressure control, including clinical inertia, medication adherence challenges, inaccurate blood pressure assessment, and difficulties implementing guideline-directed treatment strategies in routine practice.

Throughout the discussion, the panelists examine evolving approaches to hypertension management, including the growing use of combination therapies and strategies to improve patient adherence while minimizing treatment burden. They also share practical experiences navigating patient concerns about initiating antihypertensive therapy and discuss how treatment decisions are individualized based on patient characteristics and preferences.

A major focus of the conversation is the recognition of secondary causes of hypertension. The panel of experts reflects on how traditional assumptions regarding the rarity of secondary hypertension may contribute to underdiagnosis and missed opportunities for intervention. They discuss why clinicians may not routinely evaluate for reversible causes of hypertension and consider the potential implications for patient outcomes when secondary drivers are overlooked.

The faculty emphasize the importance of improving hypertension control as a means of reducing cardiovascular risk and highlight the need for greater awareness of conditions that may contribute to treatment-resistant disease. This discussion provides valuable context for understanding the evolving role of hypercortisolism and other secondary causes of hypertension in cardiovascular practice.

In the next episode, ‘Hypercortisolism as a Driver of Hypertension and Cardiovascular Risk’, panelists will continue their discussion on hypercortisolism and highlight how cortisol excess can contribute to hypertension and cardiovascular risk even in the absence of classic Cushing syndrome features. They also explore emerging evidence linking hypercortisolism to adverse cardiometabolic outcomes and the implications for cardiovascular practice.

In this episode, ‘The Challenge of Resistant Hypertension,’ features the panelists discussing persistent barriers to blood pressure control, evolving hypertension management strategies, and the importance of recognizing secondary causes of resistant hypertension. They also explore how missed opportunities for diagnosis may contribute to ongoing cardiovascular risk in clinical practice.

Martha Gulati, MD, MS, FACC, FAHA

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