Objective To assess the efficacy, safety, and economy of Total flavones of Hippophae Rhamnoides L. (TFH) for Essential Hypertension. Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2009), MEDLINE (1950 to June 2009), EMbase (1980 to June 2009), CNKI (1995 to June 2009), and VIP (1989 to June 2009). We also handsearched the relevant journals and conference proceedings. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses using the Cochrane Collaboration RevMan 5.0 software. Results Only seven trials involving 644 patients were included. The results of meta-analyses showed that TFH had the similar effects to calcium-channel blocker (CCB) (WMD 2.34, 95%CI –0.86 to 5.53) and angiotensin-converting enzyme inhibitor (ACEI) (WMD –0.01, 95%CI – 0.97 to 0.95) in decreasing diastolic blood pressure, but TFH plus CCB was superior to CCB in decreasing systolic blood pressure (Plt;0.000 01) and diastolic blood pressure (Plt;0.000 01). TFH was inferior to ACEI in improving left ventricular posterior wall thickness (LVPWT) (Plt;0.000 01) and inter ventricular septum thickness (IVST) (Plt;0.000 01), but TFH plus CCB was more effective in improving LVPWT (Plt;0.000 01) and IVST (Plt;0.000 01). Moreover, TFH was similar to ACEI in regulating blood β2-microglobulin (WMD –0.57, 95%CI –1.18 to 0.04), creatinine clearance rate (P=0.19), and urinary albumin value in 24 hours (P=0.42). The incidence of adverse effects was significantly lower in the TFH group compared to the ACEI group. Conclusion The evidence available shows that TFH may decrease systolic and diastolic blood