Primary aldosteronism (PA) treatment with mineralocorticoid receptor antagonists (MRAs) is effective but limited by side-effects and low potency of currently available options. Finerenone, a novel MRA, has emerged as a promising alternative but data in PA are lacking. This report presents a real-world study wherein PA patients on eplerenone were forced to switch to finerenone therapy during a national shortage. During treatment with finerenone, blood pressure and antihypertensive dose remained unchanged, but the proportion of patients with normal blood pressure and complete biochemical response was decreased (P = .004 and P = .008, respectively). The latter was determined by a reduction in direct renin concentration, a biomarker previously associated with increased cardiovascular risk in PA. Although these results could be explained by finerenone's unique pharmacokinetics and mechanism of action, further studies are needed to evaluate longitudinal outcomes associated with these findings and determine its effectiveness in PA treatment.