Systemic hemodynamic atherosclerotic thrombosis syndrome (SHATS) is a syndrome of systemic atherosclerotic vascular diseases. It is caused by the pulsatile hemodynamic stress (i.e., blood pressure variability, BPV) generated by central arterial pressure and blood flow, combined with multiple thrombotic and metabolic risk factors, and driven by their interaction and synergy. It often leads to damage in multiple target organs such as the heart, brain, and kidneys. Assessment and intervention for BPV and arterial diseases can not only delay the progression to hypertension in young patients but also reduce the risk of cardiovascular disease and organ damage in elderly patients. This article systematically reviews the pathophysiological mechanisms of SHATS, including the vicious cycle between BPV and arterial stiffness, as well as its impact on target organ damage and cardiovascular event risk. It also summarizes and provides an outlook on the diagnosis, scoring criteria, and treatment of SHATS, aiming to deepen the clinical understanding of SHATS and offer new perspectives for the early identification and intervention of cardiovascular risk.