Cortisol and blood pressure: what the link is and when to see a clinician

Cortisol helps keep blood pressure steady, and the two are tied together in a few medical conditions. For most people with a high reading, though, cortisol is not the reason. MedlinePlus says the most common type is primary high blood pressure, which usually develops over time as you get older. A cortisol test is not the place to start. A proper blood pressure check is.

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A basic metabolic panel doesn't measure blood pressure or cortisol. It shows sodium and potassium, among other markers. High blood pressure together with low potassium is one reason a clinician may check aldosterone.

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Can cortisol raise blood pressure?

NIDDK lists blood pressure among the things cortisol helps maintain, along with blood sugar, inflammation and energy use. In Cushing’s syndrome the body makes too much cortisol over a long period. NIDDK includes high blood pressure among the health problems Cushing’s syndrome can cause, and MedlinePlus lists it with high blood glucose, easy bruising, a rounded face and wide purple stretch marks.

Two points keep this in proportion.

• It is rare. NIDDK says Cushing’s syndrome caused by the body itself is rare, with estimates of about 40 to 70 people per million. The most common cause overall is taking glucocorticoid medicines, such as prednisone, for a long time. If you take one, ask your prescriber about your blood pressure. Don’t stop or change it on your own.
• It is hard to spot from blood pressure alone. NIDDK says that in people with type 2 diabetes and glucose that stays too high, along with high blood pressure, Cushing’s syndrome may be the cause. That is a reason to raise both with a clinician. It is not a reason to assume.

Clinicians screen for Cushing’s syndrome with a late-night saliva test, a 24-hour urine collection or a dexamethasone suppression test, and usually two of them, because NIDDK says no one test is perfect. See testing for high cortisol and high cortisol.

What about everyday stress?

MedlinePlus says the hormones released under stress can raise blood pressure, heart rate and blood sugar, and that stress lasting a long time may play a part in developing high blood pressure. It names stress hormones in general, not cortisol on its own.

Studies that measure cortisol are observational. In one cohort of petroleum-industry workers in Xinjiang, China, people with higher hair cortisol had higher rates of high blood pressure, and higher job stress went with both (PLOS ONE, 2023). The authors note that the hair-sample group was small, which may have affected the results. A study like this can show a link. It can’t show that cortisol raised anyone’s blood pressure. It’s the only study of this kind we cite here, so treat it as one data point. Our page on saliva, urine and hair tests covers how those measures compare.

Does cortisol raise heart rate?

A 2025 paper describes two stress systems. One releases adrenaline and noradrenaline, which raise heart and breathing rate. A second, the HPA axis, releases cortisol (Sports Medicine - Open, 2025). On that description, a pounding pulse during a stressful moment isn’t, by itself, a sign of high cortisol.

Palpitations have many causes. MedlinePlus says to seek emergency care if you have chest pain or shortness of breath, or think you’re having a heart attack. If palpitations keep coming back, see a clinician.

Can low cortisol cause low blood pressure?

NIDDK lists low blood pressure that drops further when you stand up, with dizziness or fainting, among the symptoms of adrenal insufficiency. The more common symptoms are long-lasting fatigue, muscle weakness, loss of appetite, weight loss and abdominal pain. See low cortisol symptoms.

Vomiting you can’t stop, fainting, or severe weakness are not reasons to wait for a test. They need urgent care. See adrenal crisis.

The hormone cause people miss: aldosterone

Aldosterone is another adrenal hormone. MedlinePlus says it helps keep blood pressure stable by balancing sodium and potassium. Primary aldosteronism, also called Conn syndrome, usually comes from a benign tumor on an adrenal gland that makes extra aldosterone.

A 2022 review says it is the most common form of secondary high blood pressure. Citing earlier work, it puts the share at 5 to 10 percent of people with high blood pressure in primary care and up to 30 percent of those whose pressure is hard to control (Endocrine, 2022). That is a different measure from the Cushing’s figure above, since it counts people who already have high blood pressure.

MedlinePlus says an aldosterone test may be needed if you have high blood pressure that:

• happens with low potassium
• doesn’t improve with usual blood pressure medicines
• develops at a young age

The usual screening test is the aldosterone-to-renin ratio, a blood test. The review says medicines can change the result, so preparation has to be planned with the clinician who prescribes them. MedlinePlus says not to stop a prescribed medicine unless your provider tells you to. That makes this a test to arrange with the clinician managing your blood pressure. See the aldosterone-to-renin ratio page.

A basic blood panel shows sodium and potassium, and MedlinePlus lists abnormal sodium or potassium on an electrolyte test as one reason to look at aldosterone. A panel isn’t the screening test for it, though. See electrolytes and the adrenal glands.

When to see a clinician

• Your readings are high or you’re unsure. MedlinePlus says high blood pressure usually has no symptoms and is diagnosed from two or more cuff readings at separate appointments. Seek care right away if a reading is higher than 180 over 120.
• High blood pressure comes with signs of Cushing’s syndrome. NIDDK lists weight gain, thin arms and legs, a round face, easy bruising, wide purple stretch marks and weak muscles.
• Low blood pressure comes with long-lasting fatigue, weakness, weight loss or dizziness on standing.
• You take a steroid medicine. Tell the prescriber about any blood pressure change. Don’t stop it yourself.

Bring a list of everything you take. MedlinePlus says secondary high blood pressure can come from another medical condition or from certain medicines, and a clinician has to sort out which.

Keep reading

• Effects of high cortisol

  What long-term high cortisol can do and how it is worked up.

• Low cortisol symptoms

  What each symptom can mean, and what doesn't point to cortisol.

• Aldosterone-to-renin ratio

  The blood test used to look for too much aldosterone.

• Cortisol and stress

  What stress does to cortisol and what it doesn't.