Primary hyperaldosteronism (PH) is common cause of secondary hypertension with autonomous aldosterone overproduction by adrenal cortex with high plasma aldosterone, suppressed renin and high blood pressure. Patients with PH have compared to essential hypertension (EH) more frequent subclinical organ damage and higher cardiovascular risk (CV). Higher carotid IMT, arterial stiffness and microalbuminuria was found in PH. Early specific therapy of PH may lead to the regression of target organ damage and decrease of CV risk. Early diagnostic and therapeutic measures are very important due to high prevalence of PH.