Objective: To analysis the cardiac structural changes of patients with primary aldosterone (PA) and the evolution after treatment with spironolactone in idopathic hyperaldosteronism (IHA). The association between cardiac structutal changes and aldosteronism levels and treatment with spironolactone is also investigated. Methods: 172 patients with PA were enrolled and 100 patients with essential hypertension (EH) served as control group. All the clinical data of these patients were collected. At baseline, biochemical, hormones and echocardiographic parameters of PA group were compared with those of patients with EH. During follow-up, 38 patiens with idopathic hyperaldosteronism (IHA) who were given spironolactone underwent biochemical, plasma aldosterone level and echocardiographic assements. The clinical data including blood pressure, aldosteronism levels and echocardiographic parameters after follow-up were compared with those data on baseline in those patients for analyzing. Results: Ventricular volumes，wall thickness and left ventricle mass index (LVMI) were greater in patients with EH than PA (P<0.01) and positively correlated with systolic blood pressure (P<0.05). LVMI decreased significantly in patients with IHA after follow-up (P<0.01), and the major influence factor was the plasma aldoterone level lowing. Conclusion: Cardiac structural changes greater in PA group compared with EH group and positively correlated with systolic blood pressure. Treatment with spironolactone would ameliorate the cardiac structural changes especially the cardiac hypertrophy in patients with IHA.