Abstract: Hypertension, a cardiovascular syndrome characterized by persistently elevated systemic arterial pressure, affects nearly one-third of the global adult population and remains a leading chronic disease contributing to multi-organ damage in the heart, brain, kidneys, and other vital systems. While randomized controlled trials offer causal insights, their application is often constrained by sample size limitations, high costs, and ethical considerations. In recent years, Mendelian randomization (MR) has emerged as a powerful approach for causal inference in hypertension research by leveraging genetic variants as instrumental variables. MR studies have already shed new light on the etiology of hypertension, elucidated mechanisms of target organ damage, and identified potential therapeutic targets. This review synthesizes current advances in MR-based hypertension research and discusses its prospective applications and potential in clarifying disease etiology, guiding precision prevention, and informing novel treatment strategies.