Primary aldosteronism (PA) is typically managed with mineralocorticoid receptor antagonists (MRAs) barring adrenalectomy.The efficacy of esaxerenone, a nonsteroidal MRA, were explored in patients with PA.Various parameters such as the urinary albumin to creatinine ratio (UACR) and serum levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were evaluated in 25 PA patients before and 3 and 6 mo after esaxerenone treatment.Systolic and diastolic blood pressure (BP), and the estimated glomerular filtration rate decreased after treatment, while serum levels of potassium and active renin increased.Significant reductions were observed in UACR 3 and 6 mo after treatment.A significant decrease in NT-proBNP was evident at 6 mo but not 3 mo after treatment.Correlation anal. indicated that the reductions in BP and UACR at 3 mo were independent of estimated daily salt intake.Furthermore, the effect of esaxerenone treatment on lowering UACR and NT-proBNP levels was independent of BP reductionResponders whose systolic BP decreased 6 mo after esaxerenone treatment by more than 10 mmHg compared to pretreatment had higher pretreatment NT-proBNP and similar UACR before and after treatment when compared with nonresponders.Esaxerenone improved mental, phys., and social quality of life (QOL) 6 mo after treatment compared to healthy controls and increased over time.No patients discontinued treatment due to severe hyperkalemia or renal dysfunction.In conclusion, esaxerenone is a safe and effective MRA for PA treatment, offering significant benefits in terms of hypertension, albuminuria, NT-proBNP levels, and QOL improvement.Esaxerenone effectively lowers BP, UACR, and serum levels of NT-proBNP independent of dietary salt intake in mild PA patients.ARC active renin concentration, DBP diastolic blood pressure, MR mineralocorticoid receptor, MRA mineralocorticoid receptor antagonist, NT-proBNP N-terminal pro-brain natriuretic peptide, PA primary aldosteronism, QOL quality of life, SBP systolic blood pressure, SF-36 Medical Outcomes Study 36-Item Short-Form Health Survey, UACR urinary albumin to creatinine ratio. [graphic not available: see fulltext].