The Interplay Between Blood Pressure and Cortisol: A Review of Current Evidence

Abstract

Cortisol, the body’s principal glucocorticoid hormone, is a vital component of the stress response and plays an essential role in maintaining homeostasis. During periods of physical or psychological stress, cortisol secretion is upregulated as part of the hypothalamic-pituitary-adrenal (HPA) axis activation. One of cortisol’s key physiological effects is its influence on cardiovascular function, specifically, its ability to modulate blood pressure (BP) through multiple mechanisms, including vascular tone regulation, fluid retention, and interaction with the renin-angiotensin-aldosterone system (RAAS). Accumulating evidence has shown that persistently elevated cortisol levels, whether due to chronic stress, dysregulation of the HPA axis, or pathological conditions like Cushing’s syndrome, are strongly associated with the development of hypertension. This review critically examines the complex relationship between cortisol and blood pressure, bringing together insights from clinical research, endocrine physiology, and experimental models. It outlines how enzymes such as 11β-hydroxysteroid dehydrogenase (11β-HSD), which regulate intracellular cortisol activity, and the sensitivity of mineralocorticoid receptors (MRs) in key organs such as the kidneys, play central roles in mediating cortisol’s pressor effects. The review also highlights key gaps in current understanding, including individual variability in hormonal response, genetic predispositions, and the challenge of differentiating physiological from pathological cortisol elevations. By integrating mechanistic data with clinical findings, this paper emphasizes the potential for using cortisol-related biomarkers in the early diagnosis of hypertension and proposes new directions for therapeutic intervention. Ultimately, understanding cortisol’s contribution to blood pressure regulation is crucial not only for managing endocrine disorders but also for addressing one of the most prevalent cardiovascular risk factors worldwide.