Hypertension is the most common cardiovascular disease in clinical practice. The pathogenesis of hypertension is relatively complex and remains under ongoing research. Currently, the medical community's understanding of the mechanisms underlying acupuncture treatment for hypertension is not yet fully understood. As a remarkably effective clinical auxiliary therapy in Traditional Chinese Medicine, acupuncture is more readily accepted by the general public due to its characteristic of causing no significant adverse reactions. Therefore, elucidating the therapeutic mechanisms of acupuncture for hypertension is of great significance for guiding clinical practice. The mechanisms of acupuncture in treating hypertension encompass multiple aspects, including ameliorating vascular endothelial remodeling, regulating the central nervous system and neuroendocrine system, improving oxidative stress responses, modulating the expression of vascular endothelial-related genes, and preventing target organ damage. Thus, this article aims to review and analyze the mechanisms of acupuncture in treating hypertension, further clarify the current research progress in acupuncture therapy for hypertension, and provide a theoretical basis for the clinical application of acupuncture in hypertension treatment.