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Background Whether primary aldosteronism (PA), the most common endocrine cause of hypertension (HTN), contributes to HTN and cardiovascular disease burden in systemic sclerosis (SSc) has never been explored. We aimed to assess the prevalence and management of HTN, prevalence of positive PA screening test results and the associations between markers of PA with HTN and SSc-related outcomes in SSc.Methods Data from adult SSc patients and normotensive healthy controls (HC) were analysed in this single-centre study. HTN was defined as blood pressures ≥140/90 mm Hg on two visits or as documented in medical records. PA screening was performed using the aldosterone:renin ratio (ARR). Associations between biomarkers of PA (renin, aldosterone, ARR, hybrid steroid 18-hydroxycortisol (18OHF)) with HTN and SSc-related outcomes were assessed using multivariable regression modelling.Results Data from 112 SSc patients (median (IQR) age 60 (49, 69) years, 79% female) and 48 HC (median (IQR) age 42.5 (31, 57) years, 52% female) were analysed. At baseline, 41 SSc patients (37%) had HTN, increasing to 52% of the cohort at the last follow-up visit (median follow-up 5.1 years). The prevalence of positive baseline ARR in SSc was 8% (9/112), corresponding to 12% (5/41) in the hypertensive subset. No associations were observed between biomarkers of PA and SSc-related renal and cardiovascular outcomes or HTN at last follow-up visit.Conclusions HTN was common in this SSc cohort, and prevalence of positive PA screening test was estimated at 12% among hypertensive SSc patients, supporting consideration of PA screening in this population.