The hydrogen evolution reaction (HER) is the core reaction of energy conversion technologies such as electrochemical hydrogen production, and the development of high-efficiency catalysts is the key to promoting its large-scale application. Pt-based catalysts have become benchmark materials for HER due to their excellent catalytic activity and stability, but the high cost of Pt severely limits their large-scale commercial application. To address the core issues of high cost and low atom utilization efficiency of Pt-based catalysts, electronic structure regulation, element regulation, and interface regulation have emerged as three core optimization strategies. This review systematically summarizes the research progress of these three regulation strategies in Pt-based HER catalysts: electronic structure regulation improves the intrinsic catalytic activity of Pt by adjusting the d-band center and optimizing charge distribution; element regulation achieves the balance between catalytic performance and cost through atomic doping, nitridation, and optimization of loading amount and component composition; interface regulation enhances the efficiency of electron transfer and mass transport by constructing heterojunctions, creating defect sites, and optimizing the interaction between support substrates. The reaction mechanisms of various regulation strategies are elaborated, providing a reference for the rational design and application of high-efficiency, low-cost, and stable Pt-based HER catalysts.