Hypertension remains one of the most prevalent and consequential conditions managed in primary care. However, a substantial proportion of patients fail to achieve adequate blood pressure control despite multiple medications. Aldosterone excess, through both overt primary aldosteronism and broader aldosterone-driven pathophysiology, is now recognized as a far more common contributor to difficult-to-control hypertension than previously appreciated, representing a critical gap in clinical recognition and management.

Aldosterone synthase inhibitors (ASIs) represent a novel mechanistic approach that directly targets aldosterone production by inhibiting CYP11B2, offering a pathophysiologically rational strategy distinct from mineralocorticoid receptor antagonism. In this continuing medical education podcast, we review the emerging clinical trial evidence for ASIs, examining efficacy, safety considerations, and how these agents may be integrated into evidence-based treatment algorithms for patients whose hypertension is difficult to control. Clinicians will leave equipped with a clearer framework for identifying appropriate candidates and contextualizing this emerging drug class within the evolving hypertension management landscape.