The purpose of this review is to briefly summarize current knowledge on diagnosis and treatment of primary aldosteronism, the most frequent cause of endocrine hypertension. RECENT FINDINGS: The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. The detection of primary aldosteronism is of particular importance, not only because it provides an opportunity for a targeted treatment but also because it has been extensively demonstrated that patients affected by primary aldosteronism are more prone to cardiovascular events and target organ damage than patients with essential hypertension. The diagnosis of primary aldosteronism is a three-step process; screening, confirmation and subtype diagnosis. SUMMARY: We review, the strategies to correctly identify primary aldosteronism, highlighting the central role of the new guidelines and the diagnostic aspects still under debate.