Decrease in blood pressure (BP) is the major goal of adrenalectomy for primary aldosteronism. Nevertheless, the optimal timing to assess these outcomes and the needed duration of follow-up are uncertain. We systematically reviewed the literature regarding trends in BP-related outcomes during follow-up after adrenalectomy. A systematic literature search of medical literature from PubMed, Embase and the Cochrane Library regarding BP-related outcomes (i.e. cure of hypertension rates, BP and antihypertensives) was performed. The Quality In Prognosis Studies risk of bias tool was used. Of the 2057 identified records, 13 articles met the inclusion criteria. Overall study quality was low. In multiple studies, the biggest decrease in BP was shown within the first month(s) after adrenalectomy and afterwards BP often remained stable during long-term follow-up. Based on the available studies one might suggest that long follow-up is unnecessary, since outcomes seem to stabilize within the first months. •The needed follow-up duration after surgery for primary aldosteronism is not clear.•This systematic review clarifies the course of blood pressure decrease post surgery.•Studies show that blood pressure seems to decrease the most within the first months.•Long follow-up after surgery might be unnecessary.