Abstract: Against the backdrop of suboptimal hypertension control and frequent target organ damage in young and middle-aged adults, this case report demonstrates high-quality blood pressure management within a tiered healthcare system. The patient was a 39-year-old male with grade 3 hypertension, renal insufficiency (stage G2A3), and massive proteinuria. A collaborative model was implemented, involving initial community screening, definitive diagnosis of hypertensive renal injury at a tertiary hospital with initiation of an intensive, renoprotective combination therapy, followed by long-term follow-up in the community. Intelligent technology facilitated intensive blood pressure monitoring to guide management. After 10 weeks, significant improvements were observed in blood pressure levels, blood pressure variability, and time in therapeutic range, along with a marked reduction in proteinuria and stable renal function. Annual assessment confirmed no progression of target organ damage. This case illustrates that an integrated, collaborative management model within a tiered system, combined with individualized pharmacotherapy and technology-aided monitoring, can effectively achieve high-quality blood pressure control and target organ protection in young and middle-aged hypertensive patients with renal injury.