Abstract: H-type hypertension is an important risk factor for the persistently high morbidity of stroke in China. The CSPPT was an important breakthrough in the research and development of H-type hypertension drugs 1.0, with a significant impact attracting nationwide or even worldwide attention. The discovery of differences in the therapeutic efficacy between different genotypes and the consideration of the unique metabolic characteristics of the elderly have necessitated further patient stratification beyond H-type hypertension to achieve well-targeted prevention of stroke. The homocysteine metabolism pathway combined with multi-target drug therapy has opened up an exciting potential research direction. This paper discusses the causes, research history and current status of H-type hypertension, and summarizes direction for further research, aiming to facilitate the precision prevention and control of H-type hypertension and stroke.