Abstract: Objective To compare the clinical features of asymptomatic intracranial arterial stenosis（aICAS） in patients with primary aldosteronism（PA） and essential hypertension（EH） and to analyze the risk factors of aICAS. Methods From January 2020 to December 2021, 842 patients who consecutively visited Ruijin Hospital for investigating the cause of hypertension were recruited, including 264 PA and 578 EH patients. Among the patients with PA, EH and all hypertensives, based on intracranial magnetic resonance angiography（MRA） results, patients were respectively divided into three groups: normal, intracranial atherosclerosis（ICA） group（stenosis rate＜50%） and aICAS group（stenosis rate≥50%）. The differences of clinical characteristics among the three groups were compared. Multivariate logistic regression was used to analyze the influencing factors of aICAS. Results The prevalence of AICS in PA group was significantly higher than that in EH group（7.6% vs 3.8%, χ~2=5.433, P=0.020）. The PA patients with aICAS and ICA had older age, longer duration of hypertension than normal group, and the patients with aICAS had higher upright plasma aldosterone concentration and higher systolic blood pressure than ICA group and normal group（all P＜0.05）. Multivariate logisitic regression analysis showed that duration of hypertension（OR=1.110, 95%CI 1.045-1.179, P=0.001）, systolic blood pressure（OR=1.035, 95%CI 1.011-1.061, P=0.005）, 24 h urinary aldosterone levels（OR=1.002, 95%CI 1.001-1.004, P=0.005） and low density lipoprotein cholesterol（LDL-C）（OR=2.302, 95% CI 1.139-4.656, P=0.020） were independent risk factors for aICAS in PA patients. Conclusions PA patients have higher prevalence of aICAS. aICAS is associated with the long duration of hypertension, elevated systolic blood pressure, high 24-hour urine aldosterone levels and high LDL-C levels in PA patients.