This systematic review and meta-analysis evaluates the effectiveness of acupuncture in treating insomnia symptoms in hypertensive patients. The study included 16 randomized controlled trials (RCTs) involving 1,309 patients. The results indicate that acupuncture significantly reduces insomnia symptoms, as evidenced by a greater decrease in the Pittsburgh Sleep Quality Index (PSQI) score (MD = −3.1, 95% CI [−3.77 to −2.62], p < 0.00001). Additionally, acupuncture was found to improve both systolic and diastolic blood pressure more effectively than the control group (SBP: MD = −10.31, 95% CI [−16.98 to −3.64], p = 0.002; DBP: MD = −5.71, 95% CI [−8.19 to −3.23], p < 0.00001). These findings suggest that acupuncture not only improves sleep quality but also lowers blood pressure in hypertensive patients with insomnia. The study highlights the need for further research to optimize acupuncture points and treatment durations for maximum therapeutic effects.This systematic review and meta-analysis evaluates the effectiveness of acupuncture in treating insomnia symptoms in hypertensive patients. The study included 16 randomized controlled trials (RCTs) involving 1,309 patients. The results indicate that acupuncture significantly reduces insomnia symptoms, as evidenced by a greater decrease in the Pittsburgh Sleep Quality Index (PSQI) score (MD = −3.1, 95% CI [−3.77 to −2.62], p < 0.00001). Additionally, acupuncture was found to improve both systolic and diastolic blood pressure more effectively than the control group (SBP: MD = −10.31, 95% CI [−16.98 to −3.64], p = 0.002; DBP: MD = −5.71, 95% CI [−8.19 to −3.23], p < 0.00001). These findings suggest that acupuncture not only improves sleep quality but also lowers blood pressure in hypertensive patients with insomnia. The study highlights the need for further research to optimize acupuncture points and treatment durations for maximum therapeutic effects.