Sensing technology serves as a cornerstone for health and environmental monitoring, yet its advancement is constrained by the inadequate biocompatibility and mechanical compatibility of traditional interface materials. Hydrogels, as a class of hydrophilic three-dimensional network soft materials, offer an ideal platform to address this bottleneck owing to their biomimetic features and tunable physicochemical properties. For the first time, this review systematically summarized and elaborated on eight rational design paradigms for hydrogel-based sensors, including functional nucleic acid programming, enzymatic catalysis and biomolecular recognition, synthetic supramolecular modules, nanocomposite integration, physical confinement effects, stimulus-responsive polymer systems, microneedle-based sensing, and flexible wearable device integration. These paradigms clarified the central role of hydrogels as either active responsive units or passive optimization matrices across different strategies. The work aims to provide a systematic rational design framework for relevant research, facilitating a paradigm shift in the field from empirical exploration toward rational construction.