Vol. 8, Issue 3, Part C (2025)

Hypertension is one of the most prevalent chronic conditions worldwide and frequently coexists with other non-communicable diseases, creating a challenging clinical scenario referred to as multimorbidity. This paper critically reviews current strategies for managing hypertension in multimorbid patients, with a focus on the integrative role of internal medicine. Through a narrative review of clinical trials, cohort studies, and clinical guidelines from 2010 to 2025, the paper synthesizes evidence surrounding individualized blood pressure targets, polypharmacy, deprescribing, and guideline conflicts. Findings indicate that major hypertension trials, such as SPRINT and ACCORD, often exclude patients with multimorbidity, limiting the generalizability of their conclusions. Observational data and real-world evidence underscore the risks of aggressive BP lowering in frail populations, suggesting a need for tailored targets. The analysis identifies clinical inertia, adverse drug interactions, and conflicting disease-specific guidelines as major barriers to optimal care. It also highlights the growing relevance of deprescribing strategies, multidisciplinary collaboration, and digital health tools. Internal medicine's holistic and systems-based approach is positioned as central to navigating these complexities. The paper argues for the evolution of clinical practice from disease-centric to patient-centered models, incorporating social determinants, patient preferences, and long-term functionality as key metrics of success. It concludes with actionable recommendations for personalized care, integration of decision support systems, and expansion of multidisciplinary care models. Ultimately, this work aims to realign hypertension management strategies with the realities of multimorbidity, leveraging the strengths of internal medicine to enhance outcomes