Hypertension requires long-term therapy, but conventional oral drugs often suffer from short half-lives, variable plasma levels, and poor adherence. Push–pull osmotic pump (PPOP) systems offer sustained and predictable drug release, improving efficacy and compliance in antihypertensive therapy. This review outlines the design, formulation strategies, and advantages of PPOPs, with emphasis on applications for calcium channel blockers and beta-blockers. Recent advances such as chronotherapeutic systems, novel excipients, and 3D printing are discussed, alongside clinical benefits and challenges in scale-up and regulation. PPOPs represent a promising platform for sustained hypertension management and future personalized therapy.