High Blood Pressure and Hormones
One form of secondary hypertension-that is, high blood pressure with a known cause-is hormone-related hypertension. In this case, the overproduction or underproduction of various hormones causes excessively high blood pressure.
The main forms are:
- pheochromocytoma, which is the cause in around 0.2 to 0.4 percent of all cases of hypertension,
- Cushing's syndrome, which accounts for around 0.3 percent of patients with high blood pressure, and
- Conn's syndrome, which accounts for the largest proportion of hormone-related high blood pressure, at around 12 percent.
- Hyperthyroidism/hypothyroidism (see separate article)
Pheochromocytoma
Pheochromocytoma is a usually benign tumor of the adrenal medulla. In some cases, it occurs as an extra-adrenal pheochromocytoma (paraganglioma) outside the adrenal gland, near the spine or the large blood vessels, and then originates from a part of the autonomic nervous system that runs along the spine (the sympathetic trunk); the autonomic nervous system cannot be consciously controlled. It is considered rare (there are two to eight new cases per million people each year). It causes an overproduction of catecholamines such as adrenaline, noradrenaline, and dopamine, which is also responsible for any symptoms that may occur. Most patients have high blood pressure, either continuously or in episodes. Throbbing headaches, sweating, palpitations, and paleness may also occur.
Cushing syndrome
Cushing's syndrome involves an abnormally increased production of cortisol, an adrenal hormone. The cause is usually a benign tumor of the pituitary gland. This results in an overproduction of the hormone ACTH, which in turn stimulates adrenal hormone production, leading to increased cortisol secretion.
In rarer cases, adrenal tumors directly produce too much cortisol. This affects blood pressure regulation by the kidneys and can therefore lead to high blood pressure. It can also result in an insufficient supply of potassium, which may impair circulatory function. Other important consequences of hormone overproduction include what is known as moon face, fat accumulation around the trunk, stretch marks on the skin (striae), the development of diabetes, muscle wasting, susceptibility to infections, depressed mood, and more.
Conn syndrome
Conn syndrome-also known as primary hyperaldosteronism-is one of the most common causes of secondary hypertension. It is a disorder of the adrenal glands that causes overproduction of the hormone aldosterone. Aldosterone plays a key role in regulating water and salt in the body. Through its effect on salt transport, aldosterone causes potassium to be excreted and sodium salt and water to be reabsorbed. This means that too little salt is excreted, and the resulting increase in fluid volume in the vascular system leads to high blood pressure.
There are two different causes of this condition: On the one hand, the adrenal glands may be enlarged (bilateral
adrenal cortical hyperplasia) and therefore produce too much aldosterone. On the other hand, there may be benign tumors (adenomas) on the adrenal gland that also produce aldosterone and increase its level. The first cause is slightly more common, accounting for around 60% of all cases of Conn syndrome. It can often be treated effectively with medication. In both cases, Conn syndrome is considered highly treatable and, if surgery is performed, even curable.
adrenal cortical hyperplasia) and therefore produce too much aldosterone. On the other hand, there may be benign tumors (adenomas) on the adrenal gland that also produce aldosterone and increase its level. The first cause is slightly more common, accounting for around 60% of all cases of Conn syndrome. It can often be treated effectively with medication. In both cases, Conn syndrome is considered highly treatable and, if surgery is performed, even curable.
There are also several other, but very rare, causes of Conn's syndrome. However, if left untreated, Conn's syndrome often leads to serious secondary diseases and organ damage. The high blood pressure caused by the syndrome leads to these secondary diseases and organ damage significantly more often, and they are more severe, than with other forms of high blood pressure.
High blood pressure during menopause
The development of high blood pressure in women going through menopause also has a hormonal basis. The underlying cause is not overproduction, but a decline in the production of the hormone estrogen. Until menopause, estrogen has a protective effect because it lowers blood pressure. However, estrogen production declines during menopause, and this protective effect is lost. At the same time, levels of the male hormone testosterone increase. In women-as in men-this promotes the development of abdominal fat, which can itself release appetite-stimulating hormones and thus also cause blood pressure to rise. Women can best counteract this themselves by getting plenty of exercise, eating a healthy, low-salt diet, consuming little alcohol and refraining from nicotine.
In its guidelines, the ESH (European Society of Hypertension) has included early menopause-meaning the cessation of menstrual periods before the age of 45 without this being attributable to treatment-as a risk factor for high blood pressure. Affected women are advised to check their blood pressure regularly and, if readings are too high, to begin treatment as soon as possible to prevent secondary conditions.
Regular monitoring is also recommended when hormone replacement therapy is used during menopause. The therapy does not necessarily increase blood pressure, but it may do so. Patients are therefore advised to have their blood pressure monitored and, if necessary, receive medication for high blood pressure. If this does not lower their blood pressure, they are advised to discontinue hormone replacement therapy (of course, only after consulting their treating physician).
Hormone therapies
Transgender people undergoing gender-affirming hormone therapy, in which hormones must be administered at substantially higher doses than, for example, in hormone replacement therapy during menopause, are also advised to have their blood pressure monitored. The available data are currently still inconclusive as to whether the therapy increases the risk of developing high blood pressure or other cardiovascular diseases. Nevertheless, monitoring blood pressure is recommended as a precaution.
This also applies to hormone therapies administered for other reasons.
In its guidelines, the ESH (European Society of Hypertension) has included early menopause-meaning the cessation of menstrual periods before the age of 45 without this being attributable to treatment-as a risk factor for high blood pressure. Affected women are advised to check their blood pressure regularly and, if readings are too high, to begin treatment as soon as possible to prevent secondary conditions.
Regular monitoring is also recommended when hormone replacement therapy is used during menopause. The therapy does not necessarily increase blood pressure, but it may do so. Patients are therefore advised to have their blood pressure monitored and, if necessary, receive medication for high blood pressure. If this does not lower their blood pressure, they are advised to discontinue hormone replacement therapy (of course, only after consulting their treating physician).
Hormone therapies
Transgender people undergoing gender-affirming hormone therapy, in which hormones must be administered at substantially higher doses than, for example, in hormone replacement therapy during menopause, are also advised to have their blood pressure monitored. The available data are currently still inconclusive as to whether the therapy increases the risk of developing high blood pressure or other cardiovascular diseases. Nevertheless, monitoring blood pressure is recommended as a precaution.
This also applies to hormone therapies administered for other reasons.
Acromegaly
Acromegaly is a condition caused by increased secretion of growth hormone due to a slow-growing tumor of the pituitary gland. A noticeable feature is the resulting enlargement of the extremities (= ends of the body), namely the fingers, toes, nose, chin, and cheekbones. If the condition develops before linear growth is complete, it results in unusually tall stature. However, the body proportions remain unchanged. Acromegaly not only leads to excessive growth, but also to an increase in blood volume due to reduced excretion of water and sodium. This can result in high blood pressure.
Sources
- https://leitlinien.dgk.org/files/28_2018_pocket_leitlinien_arterielle_hypertonie_aktualisiert.pdf
- http://www.endokrinologie.net/krankheiten-endokrine-hypertonie.php
- https://de.wikipedia.org/wiki/Ph%C3%A4ochromozytom
- https://www.internisten-im-netz.de/aktuelle-meldungen/aktuell/bluthochdruck-oft-durch-hormonstoerung-verursacht.html
- https://www.hochdruckliga.de/pressemeldung/items/317.html
- https://www.aerzteblatt.de/nachrichten/127776/Hormonelle-Ursachen-fuer-Bluthochdruck-bleiben-laut-Fachgesellschaft-haeufig-unerkannt
- https://idw-online.de/en/news817680
- https://journals.lww.com/jhypertension/Fulltext/9900/2023_ESH_Guidelines_for_the_management_of_arterial.271.aspx
This article is from Tensana – the leading app since 2011, helping hundreds of thousands of people monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based data and is continuously updated (as of 01/2026).
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
