Abstract: Isolated diastolic hypertension (IDH) is an important subtype of hypertension, with a prevalence of 2.5% to 7.8%. It has an insidious onset and lacks typical clinical manifestations. Relevant studies have confirmed that IDH can increase the risk of chronic kidney disease, atrial fibrillation, heart failure and other related diseases. The pathogenesis of IDH is complex. In addition to traditional mechanisms such as sympathetic nervous system activation and renin-angiotensin-aldosterone system activation, recent studies suggest that its development is closely associated with multiple factors, including gut microbiota dysbiosis, anxiety, and sleep disorders. Current interventions mainly rely on comprehensive strategies such as lifestyle modifications, traditional Chinese and Western medicine treatment, and regular follow-up and evaluation. This article systematically reviews the research progress of IDH, focusing on its pathogenesis, clinical outcomes and therapeutic strategies, aiming to enhance the cognition and attention to this disease and provide a reference for clinical diagnosis and treatment practice.