Abstract: Objective To analyze the characteristics of ambulatory blood pressure and target organ damage in patients with different types of primary aldosteronism（PA）, and to provide evidence for early clinical diagnosis and treatment of target organ damage. Methods The study subjects were 100 PA patients admitted to the hypertensive ward of the First Affiliated Hospital of Guangxi Medical University from January 2016 to March 2018, including 57 patients with aldosteroma（APA） and 43 cases with idiopathic aldosteronism（IHA）, and 295 patients with essential hypertension（EH） hospitalized during the same period. The general data, hormone, blood and urine biochemical indexes, ambulatory blood pressure, arteriosclerosis indexes and echocardiography indexes were collected. The characteristics of ambulatory blood pressure and target organ damage were compared between PA group and EH group, as well as APA group and IHA group. Results Compared with EH group, PA group showed lower serum potassium, homocysteine（Hcy）, plasma orthostatic renin activity（PRA）, and angiotensin Ⅱ（AngⅡ）, while higher plasma aldosterone concentration（PAC） and serum sodium（all P＜0.05）. The proportion of dipper blood pressure in the PA group was significantly lower than that of the EH group（15.0% vs 34.6%, P＜0.05）. The daytime average heart rate was significantly lower （71.1±8.0） vs（74.9±9.0） beat/min, while the night average heart rate was higher in PA group than those in EH group （71.3±8.3） vs（65.6±8.8） beat/min, both P＜0.05. The estimated glomerular filtration rate（eGFR） of the PA group was lower than that of the EH group 85.79（59.99-114.45） vs 99.70（72.86-125.69）mL/（min·1.73 m~2）, P＜0.05. The average heart rate of whole-day and daytime in APA group were lower than those in IHA group （69.17±7.96） vs（73.64±7.62）,（69.17±7.63） vs（74.12±7.84） beat/min, both P＜0.05. There were no significant differences in the interventricular septal thickness（IVST）, posterior wall thickness of the left ventricle（LVPWT）, and left ventricular mass index（LVMI） between the PA group and EH group, APA group and IHA group（P＞0.05）. The blood pressure rhythm between APA group and IHA group had no significant difference. The urine microalbumin to creatinine ratio（UACR） 1.40（0.60-2.50） vs 0.85（0.30-1.70）mg/mmol and 24-hour microalbuminurine（MAU） 15.7（7.82-28.75） vs 8.0（2.50-21.30）mg/24 h of APA group were higher than those in IHA group（both P＜0.05）. The independent factors related to UACR, 24 h MAU and 24 h urine protein in APA patients were all Hcy. Conclusions Patients with PA are more likely to have abnormal circadian rhythms, elevated heart rate at night, and renal impairment than patients with EH. Patients with APA have a higher incidence of hypokalemia and more obvious renal damage than patients with IHA.