It’s a cold and rainy afternoon, and you are working calmly at your desk. You start to experience a throbbing headache and profuse sweating. No, your boss hasn’t asked you to send in 20 completed project files by the end of the day. Still, your head feels fuzzy. You begin to recollect your entire day’s schedule, wondering what could be causing it. Then it hits you: it’s your hypertension pill. You forgot to take the new pill your doctor recently recommended. You rush to take your medicine and wait to feel better. Hypertension, or high blood pressure, is often described as a silent killer. It refers to the rise in the pressure that blood exerts on the walls of your arteries.¹ You never expected to be diagnosed with hypertension. You took care of all the known causes – you maintained a healthy lifestyle and healthy body weight, and did not drink or smoke. So, what could be the reason for this diagnosis?

Could it be your hormones?

Hormones are a lesser-known, but a clear cause of elevated blood pressure. They are tiny chemical messengers that help manage the different processes of the body, like growth, metabolism, breathing, and reproduction.² An imbalance in these hormones can lead to hypertension. It is very difficult to differentiate hormone-related rise in blood pressure from primary hypertension, where the cause is not identifiable. Doctors usually classify this type of persistent high blood pressure  as treatment-resistant hypertension.³

Which hormones though?

The Endocrine Society says that hypertension can manifest as one of the first symptoms in about 15 different hormonal disorders.² The adrenal gland, a  small gland that sits on the top of the kidneys, is one of the causes of treatment-resistant hypertension. This gland secretes various hormones to control the balance of salts in the blood. When it produces an excess of the hormone aldosterone, the sodium concentration in the blood increases, resulting in a rise in blood pressure as well.⁴

Why does the adrenal gland secrete excess hormones?

The causes of excess aldosterone secretion are not very clear. Some studies link it to the genetics of an individual, while others connect it to excessive cell growth in the adrenal gland, something like a tumour.⁵ Although excess aldosterone is a rare cause of hypertension, the ex-president of the Endocrine Society is now advising healthcare providers to screen people with hypertension for excess aldosterone.²

How is treatment-resistant hypertension diagnosed?

The diagnosis of treatment-resistant hypertension usually happens by elimination. Excluding all other causes of hypertension and ruling out kidney disorders is an important part of the diagnostic procedure.⁵ Performing specific laboratory tests for hormonal disorders is the only way to differentiate between the various types of hypertension and arrive at a concrete diagnosis. Doctors may even recommend getting an MRI or a CT scan to check for any unwanted growth of the adrenal glands.¹

Are there any other hormones you need to worry about?

In rare cases, there could be a few other hormonal culprits for increased blood pressure, such as  cortisol, epinephrine and norepinephrine, the thyroid hormone, and to a certain extent, insulin.^{4, 6} Epinephrine and norepinephrine, along with cortisol, are secreted by the adrenal gland. They all work together to produce the fight-or-flight response in our everyday life. It’s because of these three hormones that we feel the rush of the blood in our veins when we are in a stressful situation. An overworking adrenal gland can secrete these three hormones in varying amounts, which could then become the cause of hypertension. Studies have also shown a relationship between the changing levels of thyroid hormones and blood pressure fluctuations. Changes in insulin levels are directly linked to diabetes, and diabetes is also a well-known risk factor for hypertension.^{7, 8}

What can you do to manage such hypertension?

Other than maintaining a healthy lifestyle, a few things that could help you manage hypertension better are avoiding excess salt intake, reducing your consumption of alcohol, quitting smoking, losing excess weight, and avoiding medicines that contain steroids. You can  speak with your doctor about the recent research on medicines and their effect on hormones and whether they are advisable for you.^{1, 3, 6} All in all, our hormones can sometimes work in ways that are not the best for us. But what we can do is strive to keep the body healthy and functioning at its optimal level, de-stress from time to time, and leave the rest to science.