This systematic review and meta-analysis evaluated the effectiveness of acupuncture in treating insomnia symptoms in hypertensive patients. A total of 16 randomized controlled trials (RCTs) involving 1,309 patients were included. The results showed that acupuncture was significantly more effective than the control group in reducing insomnia symptoms, as indicated 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, improvements in both systolic and diastolic blood pressure were more pronounced in the acupuncture group compared to 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 results suggest that acupuncture not only improves sleep quality but also lowers blood pressure in patients suffering from hypertension and insomnia. The study is registered with PROSPERO under number CRD42023461760. The findings indicate that acupuncture is a promising complementary therapy for insomnia in hypertensive patients, with potential benefits for both sleep and blood pressure control. However, further research is needed to determine the optimal acupuncture points and treatment duration for maximum therapeutic effect.This systematic review and meta-analysis evaluated the effectiveness of acupuncture in treating insomnia symptoms in hypertensive patients. A total of 16 randomized controlled trials (RCTs) involving 1,309 patients were included. The results showed that acupuncture was significantly more effective than the control group in reducing insomnia symptoms, as indicated 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, improvements in both systolic and diastolic blood pressure were more pronounced in the acupuncture group compared to 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 results suggest that acupuncture not only improves sleep quality but also lowers blood pressure in patients suffering from hypertension and insomnia. The study is registered with PROSPERO under number CRD42023461760. The findings indicate that acupuncture is a promising complementary therapy for insomnia in hypertensive patients, with potential benefits for both sleep and blood pressure control. However, further research is needed to determine the optimal acupuncture points and treatment duration for maximum therapeutic effect.