Improving Recognition of Hypercortisolism in Patients with Hypertension and Cardiovascular Diseases - Episode 2

Hypercortisolism as a Driver of Hypertension and Cardiovascular Risk

Published on: June 30, 2026

Deepak Bhatt, MD, MPH, FACC, FAHA, FESC, MSCAI, Stephen Greene, MD, Martha Gulati, MD, MS, FACC, FAHA, Erin Michos, MD, Matthew J. Budoff, MD

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.

EP. 1: The Challenge of Resistant Hypertension

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EP. 2: 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.