High blood pressure (hypertension) does not always have a known cause, though various factors—such as stress, genetics, diet, and physical activity levels—can play a role. In these instances, it is referred to as primary hypertension.
However, high blood pressure can sometimes result from another medical condition. When this occurs, it is known as secondary hypertension.
Secondary hypertension accounts for up to 10% of all high blood pressure cases and nearly 30% of cases in adults aged 18 to 40.
Hormonal changes associated with certain medical conditions and life stages can contribute to high blood pressure. Diagnostic and action options vary depending on the underlying cause of the hormone-related hypertension.
How hormones affect blood pressure
Hormones are the body’s chemical messengers. They regulate vital functions, such as heart rate, and fluctuations in their levels can alter these functions.
Factors such as autoimmune diseases, certain life stages (puberty or menopause), chronic stress, and tumors can trigger hormonal changes. Sometimes, these changes occur without an apparent cause.
High blood pressure can result from hormonal changes. If levels of certain hormones are excessively high or low, blood pressure may rise.
Hormonal conditions linked to high blood pressure
Certain medical conditions characterized by hormonal changes also cause high blood pressure:
- Primary aldosteronism: The adrenal glands harvest excess aldosterone, leading to low potassium stages and high blood pressure.
- Pheochromocytoma: The body produces excess adrenaline-like hormones, causing headaches, sweating, a rapid heart rate, and high blood pressure.
- Cushing’s syndrome: The adrenal glands produce excess cortisol, leading to muscle weakness, weight gain, and high blood pressure. Thyroid disease: The body produces an excessive or insufficient amount of thyroid hormone, leading to high blood pressure and changes in weight, body temperature, hair, and skin.
- Primary hyperparathyroidism: The body produces an excess of parathyroid hormone, causing high blood pressure and elevated blood calcium levels.
Some of these conditions can also be secondary to other causes. Pheochromocytoma is a benign tumor that typically develops in the inner part of the adrenal gland. Cushing’s syndrome can result from the prolonged use of high doses of glucocorticoids.
Sex hormones and blood pressure
The relationship among sex hormones and blood pressure is complex.
A 2025 review of studies suggests that lower levels of estrogen after menopause are related with higher blood pressure, and that postmenopausal people taking estrogen as part of hormone therapy may have lower blood pressure levels.
The same review also suggests that conditions that cause high levels of androgens—such as polycystic ovary syndrome (PCOS)—may be associated with high blood pressure.
A 2024 study of 313 participants (166 women and 147 men) found that women generally had lower blood pressure readings. The authors also noted that postmenopausal participants had higher levels of systolic blood pressure, although postmenopausal status did not predict changes in blood pressure.
The suggestion between sex hormones and blood pressure is further complicated when oral contraceptives are involved.
Some health professionals do not recommend that people with hypertension use combined hormonal birth control that contains both estrogen and progestin, as these products can further raise blood pressure.
However, a 2023 review found that previous studies linking oral contraceptives and hypertension showed no differences between the hormonal components of the therapies, so the exact relationship remains unclear.
Stress hormones and blood pressure
When stress is experienced, the body responds by altering the nervous, endocrine (hormonal), and immune systems. Long-term chronic stress leads to an accumulation of physical changes, such as elevated hormone levels.
Research has linked higher levels of stress hormones to high blood pressure.
In a 2021 study, researchers monitored the levels of norepinephrine, epinephrine, dopamine, and cortisol in participants’ urine for several years and recorded who experienced their first episode of high blood pressure.
The increased risk of evolving high blood pressure was associated with a doubling of stress hormone levels, especially in people under 60 years of age.
Symptoms that suggest a hormonal cause of high blood pressure
Your doctor may recommend testing to look for an underlying cause of high blood pressure if you have certain risk factors, such as:
- high blood pressure that does not improve with treatment (resistant hypertension)
- sudden, unexplained increase in blood pressure after a period of stability
- onset of high blood pressure before age 30 without other known risk factors
- severe hypertension (greater than 180/110 millimeters of mercury [mm Hg])
- blood pressure that does not decrease during the night
- low potassium levels (hypokalemia) or low blood acidity (high pH or metabolic alkalosis)
How is high blood pressure diagnosed?
Diagnosis depends on the underlying cause of your hormonally induced high blood pressure. If you have high blood pressure and certain risk factors, your doctor may perform additional tests to confirm the suspected cause:
- Primary aldosteronism: Low potassium levels can indicate primary aldosteronism. Testing may include measuring aldosterone levels in urine and blood.
- Pheochromocytoma: Persistent high blood pressure, along with other symptoms, may indicate the presence of a pheochromocytoma. Testing may include measuring metanephrine levels in urine and blood.
- Cushing’s syndrome: Symptoms such as weight gain and fatigue can mimic those of other conditions. To confirm a diagnosis of Cushing’s syndrome, doctors will rule out other conditions and then order saliva, blood, and urine tests to measure cortisol levels.
- Thyroid disease: Symptoms can include changes in weight, body temperature, and heart rate. Doctors can often confirm the diagnosis by analyzing blood levels of thyroid hormone and calcium.
- Primary hyperparathyroidism: Symptoms may include fatigue, muscle weakness, and loss of appetite. Testing includes analyzing blood parathyroid hormone and calcium levels.
Treatment options for hormone-related high blood pressure
Treatment for secondary hypertension usually involves treating the underlying cause. Treatments for some common causes include the following:
- Primary aldosteronism: If the condition affects only one adrenal gland, doctors may recommend surgery to remove the affected gland. If surgery is not an option or if both adrenal glands are affected, the doctor may prescribe medication to control the effects of aldosterone. Pheochromocytoma: Treatment includes medication and surgery to remove the tumor from the adrenal gland.
- Cushing’s syndrome: If a glucocorticoid medication is the cause of Cushing’s syndrome, the doctor will reduce the dosage of that medication. If the cause is tumors in the pituitary or adrenal glands, doctors typically recommend removing the tumors or using radiation to shrink them.
- Thyroid disorders: To treat hypothyroidism (low thyroid hormone levels) or hyperthyroidism (high thyroid hormone levels), the doctor will prescribe medication to increase or decrease thyroid hormone production.
- Primary hyperparathyroidism: Doctors can treat most cases of hyperparathyroidism by removing the affected glands. If surgery is not an option, the doctor might prescribe medication to manage some of the symptoms.
In some cases, blood pressure-lowering medications may be part of your treatment plan. Examples of these medications include:
- beta-blockers (metoprolol, atenolol)
- angiotensin-converting enzyme (ACE) inhibitors (lisinopril, ramipril)
- angiotensin II receptor blockers (ARBs) (losartan, valsartan)
- aldosterone antagonists (spironolactone)
- aldosterone synthase inhibitors (baxdrostat)
Regardless of the cause of your high blood pressure, the doctor might recommend lifestyle changes to support heart health, such as eating a healthy diet and exercising regularly.
When to talk with a doctor
The American Heart Association recommends that anyone over 20 with normal blood pressure have their blood pressure checked by a healthcare professional once a year.
If you measure your blood pressure at home and get a high reading, measure it again. If the reading remains high, consult a healthcare professional to determine if around is cause for concern.
A blood pressure interpretation above 180/120 mm Hg constitutes a hypertensive emergency. If you get this reading, wait one minute and measure your blood pressure again. If you have no other symptoms, call your doctor to discuss treatment options.
Seek immediate medical attention if you get a reading of 180/120 mm Hg accompanied by any of the following symptoms:
- chest or back pain
- shortness of breath
- numbness or weakness
- changes in vision or speech
Takeaway
Certain medical conditions, chronic stress, and specific stages of life can cause changes in hormone levels, leading to high blood pressure. Diagnosing and treating hormonally induced high blood pressure involves identifying and treating the underlying cause.
It is important to have your blood pressure checked at least once a year. If you are diagnosed with high blood pressure, a healthcare professional can control the underlying cause and advise you on how to manage it.