Summary: The current review summarizes the current place of single pill combination of ramipryl and indapamide in the treatment of hypertension in patients with high or very high cardiovascular risk. Ramipril, an angiotensin-converting enzyme inhibitor is widely used in the treatment of hypertension. The drug's undoubted advantages, demonstrated in clinical trials, include its beneficial effect on the regression of end-organ complications of hypertension, including left ventricular hypertrophy and structural changes in the vascular system. Ramipril plays an important role in the treatment of patients with hypertension coexisting with metabolic disorders, diabetes, and diabetic kidney disease. Indapamide is more potent and have a longer duration of action compared with hydrochlorothiazide. A meta-analysis of placebo-controlled studies based on thiazides, chlorthalidone, and indapamide found similar effects for the three types of diuretics on CV outcomes A greater risk of CV events and HF has been reported with Thiazide diuretics as compared to indapamide in another meta-analysis The above-mentioned recent observations justify the recommendation of the present 2023 ESH and ESC 2024 guidelines to consider indapamid as a suitable antihypertensive agent and as similarly effective in CV prevention.