Recent evidence suggests that aldosterone decreases insulin sensitivity independent of its effects on blood pressure. This article discusses the evidence linking aldosterone to insulin resistance. Objective: The role of aldosterone in causing alterations in insulin sensitivity might be relevant in patients with inappropriately elevated circulating levels of the hormone. Aldosterone and insulin resistance might together contribute to blood pressure raise and, eventually, increased cardiovascular risk. Discussion: Evidence obtained in studies of patients with primary aldosteronism suggests that inappropriately elevated plasma aldosterone levels contribute to insulin resistance. However, the relative contribution of circulating aldosterone levels or hypertensive state itself to insulin resistance is not entirely clear. Summary: Aldosterone antagonists might be beneficial in conditions associated with insulin resistance, but more research is needed to test this hypothesis.