In recent years, due to the changes in lifestyle and diet structure, the number of overweight and obese people has increased obviously in China, and the degree of obesity is increasingly serious. The number of extremely obese patients with concomitant hypertension undergoing bariatric metabolic surgery is also on the rise. The control and standardized management of perioperative blood pressure in such patients have a significant impact on their prognosis. However, the current management process of perioperative blood pressure in patients with super obesity and hypertension still lacks the corresponding theory, experience, and evidence guidance. Herein, the authors discuss and summarize the pre-, intra-, and postoperative blood pressure management process of super obese patients with hypertension to improve the safety of bariatric surgery for such patients and reduce or even avoid the occurrence of intra- and postoperative complications.