In the past three decades, China’s obesity rate has risen sharply and has become the second largest obese population in the world. Obesity not only affects aesthetics, but also makes obese people prone to hypertension, diabetes, coronary heart disease, hyperlipidemia and other diseases, which is a major enemy of life and health. The increasing youthfulness of hypertension is also associated with the increase of obese people in the young population. It is estimated that 60% to 70% of adults have hypertension due to obesity, i.e. obesity-related hypertension. Obesity can increase the risk of hypertension and make it more difficult to control blood pressure, as well as promote the aggregation of multiple cardiometabolic risk factors and increase the risk of cardiovascular and cerebrovascular disease. Many obese patients think they are physically strong and refuse medical checkups or resist medication because of the proverbial “eating well” and “eating well and sleeping well”. In fact, obesity can cause a series of changes in the body, in the subtle threat to human life and health, this damage is often more deadly, many patients pay attention to the impact of obesity on the body, often have a variety of lesions too late. The mechanism of obesity-associated hypertension is complex, including sympathetic nervous system activation, increased cardiac output, plasma volume expansion and sodium retention, RAAS activation, insulin resistance, adipokine imbalance, inflammatory/oxidative stress, abnormal extravascular fat function, abnormal gut hormones, and sleep apnea syndrome, etc. In addition, the interaction between genetic and environmental factors is also involved in the the development of hypertension. Unfortunately, however, not many obese patients are able to successfully lose weight and maintain it over time, and most require antihypertensive medication. The treatment of patients with obesity-associated hypertension should emphasize the principle of individualization. Patients with obesity-associated hypertension often have metabolic abnormalities, such as disorders of lipid metabolism, insulin resistance and abnormal glucose tolerance, etc. Preference should be given to drugs that increase insulin sensitivity or reduce the risk of new-onset diabetes, and avoid drugs that increase weight or accelerate the progression of diabetes. In addition to drug treatment, reasonable diet prescription, moderate exercise and emotional adjustment are very important to the treatment of this part of patients. Some patients with obesity-related hypertension are accompanied by anxiety and depression, prone to pessimism and anxiety, which have adverse effects on hypertension and other diseases, and the poor psychological state can further lead to binge drinking, insomnia and other poor lifestyles, which further increase weight and create a vicious circle. Psychological support from family and friends and a friendly social environment are crucial. Many young patients refuse to take antihypertensive drugs and are resistant to long-term medication, but if blood pressure is still poorly controlled after lifestyle adjustments, medication must be used. High blood pressure can affect the heart, brain, kidneys and other vital organs, so strict control of blood pressure is even more necessary for young patients.