MOMENTUM: Hypercortisolism Present in 1-in-4 with Resistant Hypertension

Endogenous hypercortisolism was identified in more than a quarter of patients with resistant hypertension, according to findings presented at the American College of Cardiology's Annual Scientific Session (ACC.26).

Results from the screening portion of the MOMENTUM trial results suggest the condition may be a substantially more common and underrecognized driver of treatment-resistant hypertension than current clinical practice assumes.

“Resistant hypertension increases the risk of cardiovascular events like heart attacks, strokes, and heart failure, as well as kidney damage,” said Deepak L. Bhatt, MD, MPH, MBA, director of Mount Sinai Fuster Heart Hospital and Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai. “MOMENTUM shows that hypercortisolism contributes to resistant hypertension in over a quarter of patients and that screening for hypercortisolism in these challenging-to-treat patients may help physicians provide more personalized care.”

MOMENTUM Study Design and Testing Methodology

MOMENTUM (NCT06829537) was a prospective, multicenter observational study conducted at 50 US sites. Eligible participants were adults aged 18 years or older with resistant hypertension defined by American Heart Association criteria: systolic blood pressure of 130 mmHg or greater despite use of 3 or more antihypertensive medication classes including a diuretic at maximally tolerated doses, or use of 4 or more medications from different classes regardless of blood pressure level.

A total of 1086 patients were screened.

Each participant was evaluated for hypercortisolism using the 1-mg overnight dexamethasone suppression test (DST), with hypercortisolism defined as a post-DST cortisol level greater than 1.8 mcg/dL in the setting of adequate dexamethasone levels of 140 ng/dL or higher.

Key exclusion criteria were designed to minimize false-positive results and included white-coat hypertension, confirmed nonadherence to antihypertensive medications, systemic glucocorticoid exposure, impaired renal function, acute illness, severe untreated sleep apnea, and oral contraceptive use.

The primary endpoint was the prevalence of hypercortisolism. Secondary endpoints included clinical and laboratory characteristics associated with hypercortisolism, markers of primary aldosteronism, prevalence of cortisol-aldosterone co-secretion, and sex-based differences in frequency.

Hypercortisolism Identified in 27% of Screened Patients

Results presented at ACC.26 indicated 297 of the 1086 patients screened, or 27.3%, met the study definition for hypercortisolism. Among the subset of participants with hemoglobin A1c of 7.5% or higher who were taking 3 or more antihypertensive medications, the prevalence rose to 32.6%, the company reported.

According to investigators, the MOMENTUM results, if replicated, may support broader screening with the standardized DST in resistant hypertension workups.

The MOMENTUM findings should be interpreted in the context of several limitations. As an industry-sponsored observational prevalence study, the results reflect provider-referred patients at specialty sites and may not represent the broader resistant hypertension population. The DST, while standardized, can produce false positives, and the study exclusion criteria aimed to minimize but not eliminate this risk.

The results come on the heels of the CATALYST trial, which was a 2-part trial funded by Corcept Therapeutics. In the first half of the CATALYST trial, investigators found hypercortisolism in 23.8% of the 1057 patients screened with difficult-to-control type 2 diabetes. In the second half, treatment with mifepristone significantly reduced HbA1c by 1.32% compared to placebo and improved weight management over 24 weeks.

“It is now clear that hypercortisolism is more common than previously assumed in patients whose hypertension and diabetes don’t respond to standard-of-care treatments,” said Bill Guyer, PharmD, chief development officer at Corcept Therapeutics. “We are grateful to the investigators and patients who have participated in this research and hope that the findings will provide critical information to support increased screening for hypercortisolism, more accurate diagnoses and improved treatment options.”

References:

1. DL Bhatt, P Taub, Laffin L, et al. Prevalence And Clinical Impact Of Hypercortisolism In Individuals With Resistant Hypertension: Primary Results From The Momentum Study. Presented at American College of Cardiology's Annual Scientific Session (ACC.26). March 27-30, 2026. New Orleans, LA.

2. Corcept Therapeutics. Corcept Presents Data from MOMENTUM Trial at American College of Cardiology Annual Scientific Session – Corcept Therapeutics, Incorporated. Corcept Therapeutics, Incorporated. Published March 28, 2026. Accessed March 29, 2026. https://ir.corcept.com/news-releases/news-release-details/corcept-presents-data-momentum-trial-american-college-cardiology