<p>Hypertension and organ damage caused by an inappropriate balance between aldosterone and salt are deeply involved in pathologies such as chronic heart failure, chronic kidney disease, and vascular disorders. Mineralocorticoid receptor antagonists are effective not only as antihypertensives, but also as organ-protective drugs, blocking direct aldosterone-induced organ damage independent of blood pressure. In recent years, research into selective aldosterone synthase inhibitors has progressed, resulting in the development of drugs such as baxdrostat, lorundrostat, and vicadrostat. These drugs are highly selective for aldosterone synthase with little inhibition of 11β-hydroxylase, making them promising antihypertensive and organ-protecting drugs. This article summarizes the basic and clinical research on aldosterone synthase inhibitors to date and reviews their characteristics. Aldosterone synthase inhibitors are drugs with the unprecedented characteristic of reducing blood aldosterone levels. Many studies have shown that low serum aldosterone levels are associated with a reduced risk of cardiovascular events. In fact, clinical trials of aldosterone synthase inhibitors have shown that lowering serum aldosterone levels by 50–70% results in lower blood pressure and organ protection. Even a small reduction in serum or local aldosterone levels is highly likely to improve hypertension and organ damage. Clinically, lowering blood aldosterone levels is very important.　Compared to the clinical evidence for mineralocorticoid receptor antagonists, clinical evidence for aldosterone synthase inhibitors remains insufficient. How these two drug types should be used given their differences thus remains unresolved. Discussing the differences in clinical effects in the future is thus important.</p><p></p>