Abstract: Objective To investigate the clinical characteristics of neurotic hypertensives with compression on facial nerve or trigeminal nerve and the effects of microvascular decompression（MVD） on blood pressure. Methods The clinical data of 53 neurogenic hypertensive patients with facial or trigeminal nerve compression treated in neurosurgery department of the First Affiliated Hospital of Fujian Medical University from January 2015 to December 2020 were retrospective analyzed. The MVDs were performed in all patients. The intraoperative and postoperative conditions were recorded, especially the changes in blood pressure 3 months after surgery. The therapeutic effect was determined according to the blood pressure decline, drug use and the degree of symptom relief. Cure was defined as completely stop using antihypertensive drugs, systolic blood pressure（SBP） ＜140 and diastolic blood pressure（DBP） ＜90 mm Hg; marked effective was defined as SBP or DBP decreased to the normal level or SBP decreased ≥30 mm Hg and DBP decreased ≥10 mm Hg; partial relief was defined as the decrease of SBP＜30 and DBP＜10 mm Hg, the clinical symptoms of hypertension were relieved, and the dosage of antihypertensive drugs was reduced; Ineffective was defined as the clinical symptoms of hypertension were not relieved, SBP and DBP had no significant change or even increased after surgery, and the drug dosage had no change or even increased. Effective included cure, marked effective and partial remission. Results The most common responsible arteries for facial nerve and trigeminal nerve compression were: anterior inferior cerebellar artery（21 cases, 39.62%）, posterior inferior cerebellar artery（15 cases, 28.30%）, and superior cerebellar artery（11 cases, 20.75%）. Compared with the preoperative period, postoperative SBP and DBP decreased significantly SBP:（127.8±9.2） vs（146.5±17.3） mm Hg, t=6.896, P＜0.001; DBP:（76.9±8.4） vs（89.4±11.2） mm Hg, t=6.297, P＜0.001. Among all patients, 30 patients were cured（56.60%）, 10 cases were marked effective（18.87%）, 5 patients were partially relieved（9.43%）, and 8 patients were ineffective（15.09%）. The marked effective rate was 75.47% and effective rate was 84.91%. In addition, the postoperative effective rate in the left group was significantly higher than that in the right group 90.48%（19/21） vs 81.25%（26/32）, χ~2=10.503, P=0.015. The symptoms of cranial nerve compression disappeared in all patients and no serious complications occurred. Conclusion MVD has certain application in the treatment of neurogenic hypertension caused by arterial compression of facial nerve and trigeminal nerve.