Objective To investigate the role of plasma aldosterone （ALD） in the development of left ventricular hypertrophy （LVH） in women with essential hypertension （EH）， and to develop a predictive model incorporating ALD and clinical parameters to improve early detection and risk stratification of LVH. Methods A total of 200 female patients with EH were enrolled and classified into the LVH group （n = 104） and the NLVH group （n = 96）. Clinical characteristics， laboratory parameters， ALD levels， and ambulatory blood pressure monitoring （ABPM） data were systematically collected. Spearman′s rank correlation coefficient was used to evaluate the association between ALD levels and left ventricular mass index （LVMI）. Multivariate logistic regression analyses were conducted to identify independent predictors of LVH， with three models constructed： Model 1 included ALD alone； Model 2 adjusted for ALD， diabetes， 24-hour systolic blood pressure （24hSBP）， nighttime SBP （nSBP）， blood pressure load （BPL）， and nighttime blood pressure decline （NBD）； Model 3 further incorporated ALD， diabetes， blood glucose （BG）， NT-proBNP， 24hSBP， 24-hour diastolic blood pressure （24hDBP）， and arterial stiffness index （ASI）. The discriminative performance of each model was assessed using receiver operating characteristic （ROC） curve analysis， with internal validation performed to ensure robustness. Results Compared with the NLVH group， the LVH group exhibited a higher prevalence of diabetes and significantly elevated levels of BG， NT-proBNP，24hSBP， 24hDBP， and ALD， along with a smaller NBD （all P < 0.05）. Spearman′s rank correlation analysis revealed a statistically significant positive correlation between ALD and LVMI （r = 0.478， P < 0.001）. In multivariate logistic regression analysis， ALD remained an independent predictor of LVH （OR = 1.014， P = 0.002）， after adjusting for other significant variables including diabetes， BG， NT-proBNP， 24hSBP， 24hDBP， and ASI. The combined predictive model （Model 3） demonstrated the highest discriminative ability （AUC = 0.852； Hosmer?Lemeshow test P > 0.05）， surpassing models based on single predictors. Internal bootstrap validation confirmed excellent calibration and robustness of the model′s predictive performance. Conclusions Elevated plasma aldosterone concentration is an independent risk factor for LVH in women with essential hypertension. A multimodal predictive model that integrates aldosterone levels， clinical parameters， and dynamic blood pressure measurements can substantially enhance the accuracy of LVH prediction， offering a reliable approach for individualized management and early intervention in female patients with hypertension.