20-HETE (20-Hydroxyeicosatetraenoic acid) is a product of arachidonic acid metabolism and a member of the CYP450 enzyme family. It is primarily synthesized in the kidneys, liver, and vascular endothelial cells. As an effective vasoactive substance, 20-HETE plays a crucial role in regulating blood pressure, vascular tone, sodium levels, as well as cell proliferation and angiogenesis. By activating specific signaling pathways, such as MAPK and PI3K/Akt, it is involved in a variety of physiological and pathological processes. The expression and activity of 20-HETE are tightly regulated, and specificity in gene expression and mutations may lead to an increased risk of hypertension, kidney diseases, and other cardiovascular disorders.