Aldosterone is a hormone in the body that regulates water and salt balance and blood pressure stability. Anti-aldosterone drugs include spironolactone (Adequan), which has been used clinically as a potassium-preserving diuretic. In recent years, Lei’s research has found that elevated aldosterone can not only cause hypertension, but it can also act directly on the cardiovascular system, causing damage to the vascular endothelium, myocardial fibrosis and proteinuria. Spironolactone is used in patients with heart failure and acute myocardial infarction to achieve good results. It has emerged as another highlight in the treatment of hypertension: firstly, in the normotensive population, elevated blood aldosterone develops into hypertension more often than in normal people; secondly, primary aldosteronism (a form of secondary hypertension, referred to as proaldosterone) is found in hypertensive patients and can account for 5-10% of hypertensive patients, and as the severity of hypertension increases, proaldosterone can reach 20%. Finally, the good results of treating hypertension with spironolactone also demonstrate the involvement of aldosterone in the development of hypertension. For the two major comorbidities of hypertension, urinary microprotein and left ventricular hypertrophy, an excellent quantitative-effect relationship was achieved with spironolactone treatment. Aldosterone has also been found to be positively associated with abdominal circumference, total cholesterol, triglycerides, insulin, and insulin resistance in the metabolic syndrome, making spironolactone therapeutic. In hypertensive patients with elevated blood aldosterone, it is important to first identify the proaldosterone in Lei. For patients with proaldosterone, surgery is effective if an aldosterone adenoma is found on the adrenal gland, while drug therapy is also an option for those who do not want surgery or have contraindications to surgery. Screening indicators for proaldosterone are: 1) hypokalemia, but only 9%-17%; 2) plasma aldosterone-to-renin activity ratio (ARR), which is currently considered to have a high specificity and sensitivity at an ARR of 30. The diagnosis can be further confirmed at the endocrinology department when the screening index is positive. Spironolactone is a non-selective aldosterone receptor blocker, which besides blocking aldosterone is also associated with many adverse effects, such as menstrual disorders, breast tenderness, male feminization of the breast, voice changes and impotence. The new drug eplerenone (not yet available in China), which is selective for aldosterone receptors, has low affinity for androgen and progesterone receptors and therefore has relatively few side effects. These two drugs are often combined with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists in lowering blood pressure for better results, but to prevent the appearance of hyperkalemia. Anti-aldosterone therapy is currently recommended for: hypertension caused by proaldosterone, intractable hypertension, hypertension with hypokalemia and hypertension caused by obesity.