Background: Essential hypertension is a prevalent condition associated with high morbidity and mortality, with few studies directly comparing the efficacy of homoeopathic potencies in its management.Objective: This study evaluates the efficacy of centesimal (CH) and fifty millesimal (LM) potencies in managing essential hypertension.Methods: A randomized clinical trial with two parallel arms was conducted with 93 hypertensive patients over 18 months. Patients were allocated to receive individualized homeopathic treatment in either CH or LM potencies. Blood pressure (BP) measurements were collected at baseline and at regular intervals to assess efficacy.Results: Significant reductions in systolic and diastolic BP were observed in both groups. However, patients treated with LM potencies demonstrated a statistically greater reduction in BP than those in the CH group.Conclusion: LM potencies may offer a more efficacious option in the management of essential hypertension within homoeopathy.