Despite many antihypertensive options, uncontrolled hypertension remains ubiquitous. Aldosterone synthase inhibitors show significant reductions in blood pressure. They have the potential to change the way hypertension is treated. Cost and access may affect the widespread acceptance of these drugs. In the article, Luke J. Laffin and Steven Nissen discuss the promises and challenges of aldosterone synthase inhibitors. This is another breakthrough in the treatment of uncontrolled hypertension. Hypertension is the number one risk factor for cardiovascular disease.