High blood pressure and hormones

Hormone-related high blood pressure is a form of secondary hypertension that is, high blood pressure with a known cause. It happens when certain hormones are produced in too high or too low amounts, which leads to elevated blood pressure.

The most important types are:

pheochromocytoma, which causes about 0.2 to 0.4 percent of all hypertension cases,
Cushing's syndrome accounting for about 0.3 percent of patients with high blood pressure, and
Conn's syndrome, which makes up the largest share of hormone-related high blood pressure at about 12 percent.
overactive/underactive thyroid (see separate article)

Pheochromocytoma

A pheochromocytoma is usually a benign tumor of the adrenal medulla. In some cases it appears outside the adrenal gland as an extra-adrenal pheochromocytoma (paraganglioma) near the spine or large blood vessels and then arises from part of the autonomic (involuntary) nervous system that runs along the spine (the sympathetic chain). It is rare there are about two to eight new cases per million people each year. The tumor causes an overproduction of catecholamines such as adrenaline, noradrenaline and dopamine, which in turn cause the symptoms. High blood pressure occurs in most people, either continuously or in sudden episodes. There can also be pounding headaches, sweating, a racing heart and paleness.

Cushing's syndrome

In Cushing's syndrome there is an abnormally increased production of cortisol, a hormone from the adrenal glands. Most often a benign tumor of the pituitary gland (hypophysis) is the cause. This leads to excess production of the hormone ACTH, which then stimulates the adrenal glands and increases cortisol release.

In rarer cases, tumors of the adrenal gland itself produce too much cortisol directly. This affects the kidney's regulation of blood pressure and can lead to high blood pressure. It can also cause low potassium levels, which may lead to problems with circulation. Other important consequences of the hormone excess include the so-called moon face, central (truncal) weight gain, stretch marks on the skin (striae), the development of diabetes, muscle wasting, increased susceptibility to infections, depressive moods and more.

Conn's syndrome

Conn's syndrome also called primary hyperaldosteronism is one of the most common causes of secondary hypertension. It is a disorder of the adrenal glands that causes an overproduction of the hormone aldosterone. Aldosterone plays a key role in the body's water and salt balance. By affecting salt transport, aldosterone causes the body to excrete potassium and to reabsorb sodium and water. That means too little salt is excreted, and the resulting increased fluid volume in the blood vessels leads to higher blood pressure.

There are two different causes for this condition: on the one hand, the adrenal glands can be enlarged (bilateral adrenal cortex hyperplasia) and therefore produce too much aldosterone. On the other hand, there can be benign tumors (adenomas) of the adrenal gland that also produce aldosterone and raise its level. The first cause is somewhat more common, accounting for about 60% of Conn's syndrome cases. It is often well managed with medication. In both cases Conn's syndrome is considered treatable, and in the case of an operation it can even be cured.

There are a few other, very rare causes of Conn's syndrome. If left untreated, Conn's syndrome often leads to serious secondary diseases and organ damage. The high blood pressure caused by this syndrome more often and more severely leads to complications than many other forms of high blood pressure.

High blood pressure during menopause

High blood pressure in women during the menopause also has a hormonal background. Here the problem is not an overproduction, but a decrease in the production of the hormone estrogen. Until the menopause, estrogen has a protective, blood-pressure-lowering effect. During the climacteric the production of estrogen decreases and that protective effect is lost. At the same time the level of the male hormone testosterone rises. In women, as in men, this can promote the development of belly fat, which itself can release appetite-stimulating hormones and thereby also contribute to higher blood pressure. Women can best counteract this with plenty of exercise, a healthy low-salt diet, low alcohol consumption and by not smoking.

The ESH (European Society of Hypertension) has included early menopause that is, the absence of periods before the age of 45 without a medical reason as a risk factor for developing high blood pressure in its guidelines. Affected women are advised to check their blood pressure regularly and, if high values are found, to start treatment as soon as possible to prevent complications.
Regular monitoring is also recommended if hormone replacement therapy is used during the menopause. The therapy does not necessarily increase blood pressure, but it is possible. Therefore blood pressure should be monitored, and if needed treated with medication; if blood pressure cannot be lowered despite this, stopping hormone replacement therapy may be advised (of course only in consultation with the treating physician).

Hormone therapies
If transgender people undergo gender-affirming hormone therapy, where hormones are often given at much higher doses than, for example, in menopausal hormone replacement, blood pressure monitoring is also recommended. Current data are not yet conclusive about whether the therapy increases the risk of high blood pressure or other cardiovascular diseases. As a precaution, monitoring of blood pressure is advised.
This also applies to hormone therapies given for other reasons.

Acromegaly

Acromegaly is a condition caused by a slowly growing tumor of the pituitary gland (hypophysis) that leads to increased secretion of growth hormone. A noticeable result is enlargement of the extremities fingers, toes, nose, chin and cheekbones. If the disease develops before the end of the growth period, it leads to unusually tall stature (gigantism), although the proportions remain. Acromegaly not only causes excessive growth, but also increases blood volume by reducing water and sodium excretion. This can result in high blood pressure.

Sources

This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands of people monitor their blood pressure every day. Our content is based on carefully researched, evidence-based information and is continuously updated (as of 01/2026).

Author Sabine Croci is a certified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care. Since 2015 she has led the editorial team at BloodPressureDB. With additional qualifications as a paramedic, first responder, and training in various therapy and emergency areas, she provides well-founded, practical, and reliably reviewed information.