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It’s easy to blame stress or a high-salt diet for your hypertension (high blood pressure). But another factor may be a hormone called aldosterone, which helps your body regulate blood pressure by controlling how much salt and water it retains.
Sometimes, aldosterone can make high blood pressure harder to control, even if you’re taking medication. This article explains how aldosterone affects blood pressure, why it can contribute to uncontrolled hypertension, and the treatments your doctor may recommend.
Uncontrolled hypertension means your blood pressure stays too high even though you’re being treated for high blood pressure.
Your blood pressure may be considered resistant if it stays high even though you are taking three blood pressure medications from different classes — usually including a diuretic — at the highest dose you can tolerate. Resistant hypertension can also mean your blood pressure is controlled only with four or more medications.
Aldosterone is a hormone your body uses to control your blood pressure. It’s made by your adrenal glands — small, triangle-shaped glands that sit on top of your kidneys. Aldosterone regulates blood pressure by changing electrolyte levels.
Sodium and potassium are key electrolytes needed for nerve and muscle function. They’re also important for controlling your fluid balance and blood pressure. When your blood pressure drops too low, your body raises it back up.
Aldosterone tells your kidneys to hold on to more sodium, and sodium likes to hold on to water. This means the higher your sodium levels are, the more water stays in your body. Your blood volume and blood pressure rise as a result.
The renin-angiotensin-aldosterone system (RAAS) is a complex system used to control your blood pressure. It uses hormones and proteins to control fluid and electrolyte levels. Problems with the RAAS can lead to high blood pressure.
When your blood pressure drops, your kidneys release renin. Renin helps start a process that makes angiotensin 2, a substance that narrows your blood vessels and raises blood pressure. Angiotensin 2 also tells the adrenal glands to release aldosterone and stimulates the pituitary gland to release antidiuretic hormone (ADH).
ADH is a hormone that helps your body hold onto water. Along with aldosterone, it helps your kidneys keep more fluid in your body. Aldosterone also tells your kidneys to get rid of potassium in your urine, which can raise your blood pressure.
When your adrenal glands make excess aldosterone, it’s called hyperaldosteronism. Too much aldosterone can raise your blood pressure because aldosterone forces your body to hold on to more water.
Doctors used to think hyperaldosteronism was fairly rare. However, health experts estimate that as many as 25 percent of people with resistant hypertension have hyperaldosteronism.
Hyperaldosteronism is called primary or secondary depending on the cause.
Medications that affect aldosterone may be helpful for people with uncontrolled high blood pressure, whether or not they have a diagnosis of hyperaldosteronism.
Mineralocorticoid receptor antagonists are a class of medications that block the effect of aldosterone in the body. They help the body get rid of extra salt and water to lower blood pressure.
Examples include spironolactone and eplerenone. These drugs can be used for people with uncontrolled hypertension. They can also be used to treat hyperaldosteronism.
Another group of medications is called aldosterone synthase inhibitors. They work by reducing how much aldosterone your body makes. With less aldosterone, your body holds on to less salt and water, which helps lower blood pressure.
Baxdrostat (Baxfendy) is the first of this class to be approved by the U.S.
Food and Drug Administration (FDA). In May 2026, baxdrostat was approved to treat hypertension alongside other medications in people whose blood pressure isn’t adequately controlled.
It’s not a treatment for hyperaldosteronism.
If you have an adrenal adenoma, your doctor may recommend surgery to remove it. This is known as an adrenalectomy, which takes out one or both of your adrenal glands.
An adrenalectomy is usually a minimally invasive procedure. A surgeon makes several small cuts in your abdomen to remove one or both adrenal glands.
An adrenalectomy isn’t always a cure for uncontrolled hypertension. You may still need to take blood pressure medications.
Making lifestyle changes can also help control your blood pressure. Following a low-sodium diet can help reduce water retention and lower blood pressure. This is especially true for people with hyperaldosteronism who can have higher sodium levels.
Other important lifestyle changes include:
Good blood pressure control is key to staying healthy. If left untreated, uncontrolled hypertension can damage your heart and blood vessels.
Uncontrolled hypertension raises your risk of a heart attack, stroke, and heart failure. High blood pressure can also harm your kidneys, eyes, and brain.
On MyHeartDiseaseTeam, people share their experiences with heart disease, get advice, and find support from others who understand.
How do you manage aldosteronism and high blood pressure? Share your experience in the comments below.
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