Primary aldosteronism ( PA) is the most common type of secondary hypertension. Due to its high incidence of heart, brain, kidney and other complications, early identification is very important. Surgical treatment is the preferred treatment for unilateral PA, while mineralocorticoid receptor antagonists are the preferred treatment for bilateral PA. Currently, the most commonly used therapeutic drug in China is spironolactone. The side effects such as gynecomastia lead to poor patient compliance and limited efficacy. For PA patients with poor control of blood pressure and potassium, combination of epithelial sodium channel (ENaC) inhibitors and calcium channel blockers can be used. The efficacy of new drugs such as nonsteroidal mineralocorticoid receptor antagonists and aldosterone synthase inhibitors needs further research in the treatment of PA patients. The pathogenesis of familial hyperaldosteronism involves multiple gene mutations. Familial aldosteronism type I (FH-I) can be treated with glucocorticoids, FH-III can be treated with macrolides and FH-IV can be treated with calcium channel blockers. With the emergence of second-generation sequencing and other technologies, different gene mutations encoding cell membrane ion channels or ion pumps have been discovered. These drugs provide a new perspective for possible future treatments of PA.