Background:Hypertension, a prevalent cardiovascular disorder, demands effective management to prevent complications. This study aimed to conduct a comparative analysis of the efficacy, safety, and impact on the quality of life of two common antihypertensive combinations: Metoprolol with Telmisartan and Metoprolol with Ramipril.Materials and Methods:A randomized, double-blind clinical trial was conducted over a 12-month period, involving 500 hypertensive patients aged 40 to 70. Patients were divided into two groups: Group A receiving Metoprolol and Telmisartan, and Group B receiving Metoprolol and Ramipril. Baseline characteristics, including age, gender, and blood pressure levels, were recorded. Patients underwent regular follow-ups, and their blood pressure, adverse events, and quality of life were assessed at predetermined intervals.Statistical analysis was performed using SPSS version 25. Descriptive statistics were presented as mean ± standard deviation. The efficacy of each combination was assessed by measuring changes in systolic and diastolic blood pressure from baseline. Safety was evaluated by monitoring adverse events, including dizziness, fatigue, and cough. Quality of life was assessed using a standardized questionnaire.Results:The baseline characteristics of both groups were comparable. After 12 months, Group A exhibited a significant reduction in systolic and diastolic blood pressure compared to Group B (p < 0.05). The incidence of adverse events was lower in Group A (14%) compared to Group B (21%). Notably, cough was more prevalent in Group B (9%) than in Group A (3%). Quality of life scores improved in both groups, with a more pronounced enhancement observed in Group A, particularly in domains related to physical and mental well-being.Conclusion:This comparative study suggests that the combination of Metoprolol and Telmisartan is more efficacious in lowering blood pressure, safer in terms of adverse events, and has a more positive impact on the quality of life in hypertensive patients compared to Metoprolol and Ramipril. The findings emphasize the importance of tailoring antihypertensive therapy to individual patient needs to achieve optimal outcomes.