Hypertension is the primary risk factor of cardiovascular and cerebrovascular diseases. Evidence shows moxibustion therapy has obvious effectiveness on blood pressure, but the underlying mechanism remains unclear, and needs further study. In this paper, we summarize the characteristics and acting mechanism of moxibustion therapy in the treatment of essential hypertension in recent years. Moxibustion therapy, usually alone or in combination with other therapeutics, different moxibustion methods are used based on syndrome differentiation. Early application of the therapy can correct the bias of hypertension, and has certain long-term efficacy. The mechanism of its effectiveness is mainly through regulating the neuroendocrine system, improving the function of endothelial cells, regulating blood rheology, and resisting oxidative stress, and it is mutually causal with human metabolic abnormalities.