BACKGROUND: Essential hypertension (EH) remains a leading modifiable risk factor for cardiovascular morbidity and mortality worldwide. Electroacupuncture (EA), combining traditional acupuncture with pulsed electrical stimulation at specific acupoints, has attracted growing attention as a potential adjunctive strategy. METHODS: A structured narrative literature search was conducted across PubMed, Web of Science, and CNKI databases up to January 2026. Search terms combined electroacupuncture-related terms with hypertension-, mechanism-, clinical trial-, and neuroimaging-related terms. Eligible studies included preclinical hypertension models, selected mechanistic studies from related cardiovascular models, completed clinical studies, published clinical trial protocols, and neuroimaging investigations relevant to EA and blood pressure regulation. Evidence sources were categorized as direct EH-specific evidence, indirect mechanistic evidence, adjunctive clinical evidence, or protocol-based evidence. No formal systematic review methodology was applied; this review should be interpreted as an integrative narrative synthesis. RESULTS: Current evidence suggests that EA may influence blood pressure regulation through multiple preclinically supported mechanisms, including modulation of central sympathetic outflow, autonomic rebalancing, anti-inflammatory signaling, endothelial protection, and attenuation of myocardial remodeling. However, direct human evidence for EA in EH remains sparse. The current clinical literature consists mainly of one stage 1 hypertension study, adjunctive-therapy evidence, and published protocols with pending results, rather than completed, definitive EA-specific randomized trials that establish clinical efficacy. CONCLUSION: EA remains a biologically plausible but clinically unconfirmed adjunctive approach for EH. Its clinical efficacy, optimal parameters, and target populations require confirmation in completed, adequately powered, sham-controlled multicenter randomized trials.