Abstract: This review aims to analyze differential metabolites and metabolic pathways in essential hypertension based on serum metabolomics, providing new insights for early diagnosis and precise treatment. Through a comprehensive review of existing studies, this paper systematically summarized abnormalities in multiple metabolic pathways—including amino acid metabolism, fatty acid metabolism, oxidative stress, steroid hormone metabolism, and other metabolic disturbances—and their associations with blood pressure regulation. Patients with essential hypertension exhibit significant disturbances in amino acid metabolism, with levels of branched-chain amino acids, alanine, and arginine being closely associated with blood pressure. Dysregulation of short-chain fatty acid metabolism may influence blood pressure by affecting vasomotor function. Oxidative stress promotes endothelial injury and vasoconstriction. Steroid hormones such as aldosterone and cortisol may exacerbate hypertension by activating the renin-angiotensin-aldosterone system and promoting sodium and water retention. The interplay among multiple metabolic pathways collectively drives disease progression. Metabolic disorders play a critical role in the pathogenesis of essential hypertension. Metabolomic analysis helps elucidate underlying mechanisms and offers a theoretical basis for early intervention and targeted therapy.