<![CDATA[Background: Hypertension affects more than 1.2 billion adults worldwide, and most patients require at least two drugs to reach their blood pressure (BP) target. Current guidelines recommend a renin–angiotensin system (RAS) blocker plus a calcium channel blocker (CCB), but do not specify whether the RAS component should be an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). Objective: To compare the BP-lowering effects of ACEI+CCB and ARB+CCB in adults with hypertension, including target attainment, tolerability, cardiovascular outcomes, and cost. Methods: We followed PRISMA 2020 and searched PubMed, ScienceDirect, Google Scholar, and Garuda for reports published from 2020 to 2025, with additional citation searching. Eligibility was defined using PICOS. Risk of bias was assessed with RoB 2, AMSTAR 2, and Joanna Briggs Institute checklists, and findings were synthesized narratively following SWiM guidance. Results: Eight of 535 records were included: one network meta-analysis, one outcome trial, three systematic reviews, and three observational or comparative studies. Both combinations produced substantial reductions in systolic and diastolic BP. ARB+CCB ranked highest for BP reduction in chronic kidney disease, while an Indonesian cohort reported target attainment of 48.9% with amlodipine–candesartan and 45.2% with amlodipine–ramipril. ARB-based regimens caused less cough and angioedema, whereas ACEI co-therapy better offset CCB-related oedema. Conclusion: No clinically meaningful difference in BP lowering was found between combinations. Choice should consider tolerability, comorbidity, cardiovascular evidence, and cost; head-to-head trials in Indonesian patients are needed. ]]>
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