Abstract Body: Objective: Long-term blood pressure variability (BPV) is associated with an increased risk of major cardiovascular events (MACE), but it is rarely reported in patients with primary aldosteronism (PA). We aim to investigate the association between long-term BPV and cardiovascular events in patients with PA. Methods: This was a retrospective cohort study which conducted at the Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region from January 2006 to December 2021. The study included patients with PA aged over 30 years. The primary outcome was the incidence of major cardiovascular events during the follow-up, which extended until June 2023. The BPV index encompassed four parameters: standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and maximum and minimum blood pressure difference (MMD). Multivariate analysis using logistic regression was performed, adjusting for demographic variables such as age, sex, body mass index, as well as clinical characteristics including smoking and alcohol consumption. Results: A total of 2,380 patients with PA were ultimately enrolled in this study. Access to clinic blood pressure was ensured at least three times during follow-up visits, with a minimum follow-up interval of 1 month. During a median follow-up of3.6 years, there were 124 cases of MACE. The mean age of the participants was 49.36 years, with men accounting for 1,288 cases. The average blood pressure recorded was 135 mmHg. After adjusting for confounding factors such as age, sex, smoking, alcohol consumption, BMI and cardiovascular risk factors, the systolic BPV (SD, CV, ARV) was found to be significantly associated with MACE (OR= 1.03, CI 1.02-1.05; P<0.05). In the group of mean SBP≥130mmHg, SBP variability had a significant association with MACE (OR: 1.03; CI: 1.01-1.06; P<0.05). However, no significant correlation between SBP variability and MACE in group of mean SBP <130mmHg (P>0 .05). Conclusion: Focusing on long-term systolic BP SD, CV, and ARV in patients with primary aldosteronism may help to prevent the occurrence of cardiovascular events.