Abstract: Objective To investigate the relationship between metabolic syndrome（MS） and its components and left ventricular（LV） remodeling in patients with primary aldosteronism（PA）. Methods A case-control study was conducted. Between January 1, 2015 and April 15, 2021, a total of 107 PA and 214 essential hypertension（EH） patients individually matched by sex, age（±3 years）, blood pressure, and duration（±3 years） of hypertension were recruited from the First Affiliated Hospital of Fujian Medical University. Clinical data, the prevalence of MS and its components, as well as the LV remodeling were compared between the two groups. Results The prevalence of MS in PA group was significantly lower than that in matched EH group（28.0% vs 43.0%, χ~2=6.770, P=0.010）,whereas the abnormal LV configuration in PA group was higher than in EH group（64.5% vs 34.6%, χ~2=25.827, P＜0.05）. The abnormal conformation rates of centripetal remodeling, centripetal hypertrophy, and centrifugal hypertrophy in PA patients were higher than in EH patients（21.5% vs 11.7%, χ~2=5.401; 19.6% vs 9.8%, χ~2=6.040; 23.4% vs 13.1%, χ~2=5.469; respectively, all P＜0.05）. Binary logistic regression analysis showed that MS and its component hyperglycemia were independent risk factors for the abnormal configuration of LV remodeling in PA patients（OR=4.866, 95%CI 1.523-15.543 and 9.437, 95%CI 1.975-45.090, respectively, both P＜0.05）. Conclusions PA patients exhibit more severe LV remodeling than matched EH controls. MS and its component hyperglycemia are independent risk factors for LV remodeling in patients with PA.