Acupuncture has achieved favorable clinical efficacy in the treatment of essential hypertension (EH), but the central nervous system mechanism underlying its antihypertensive effect remains to be further elucidated. Magnetic resonance imaging (MRI) technology provides objective neuroimaging evidence, facilitating the exploration of hypertension-related cerebral mechanisms and the central action pathways of acupuncture intervention. This article systematically combs and summarizes three core aspects: abnormal changes in brain function and structure in patients with EH, advances in MRI-based imaging research on acupuncture for EH, and the mechanism of action of brain regions associated with the autonomic nervous system in acupuncture-induced blood pressure reduction. Based on existing neuroimaging evidence, this review further concludes the key brain regions correlated with the antihypertensive effect of acupuncture, and analyzes the limitations of current studies—such as small sample sizes, inconsistent acupuncture protocols, and short-term follow-up duration. It aims to provide a reference for in-depth revelation of the central mechanism of acupuncture in treating EH and optimization of future research designs.