A systematic approach incorporating precision-controlled experiments and high-fidelity numerical simulations has been employed to delve deeper into the physics of extreme wave impact pressures. Using a suite of high-speed imaging and high-resolution pressure sensing techniques that are accurately synchronized with the wave generation, a consistent and well-correlated set of data providing details of the focusing incident wave front, flow velocities, and impact pressure time histories has been successfully obtained. The numerical simulations using a validated incompressible smoothed particle hydrodynamics (ISPH) provided further details that were not tractable in the experiments. Based on the results obtained, there were five broad impact scenarios identified, ranging from focusing crest impacts to plunging jet impacts with varying entrapped air. Among these impact types, the highest impact pressures were those associated with a focusing wave crest. It has been found that high impact pressures were correlated with a convergence of the horizontally impinging overturning crest and the vertical surge of the wall boundary water mass, but with the overturning crest impingement just ahead of the arrival of the wall boundary water mass, which in essence amounted to the impingement of a focusing wave front. Depending on the relative arrival times of the impinging crest and the wall boundary upsurge, the impact scenarios could vary from an up-slosh to a jet impingement with a clear entrapped air pocket, followed by a flip-through of the incident crest. For the scenario with the highest impact pressures, broadly classified as type II impact in this paper, the peak pressures could reach as high as 85ρC2, an order of magnitude higher than impact scenarios without the focusing effect, such as the scenario with a plunging jet impact with entrapped air (classified as types III and IV impact in this study). As the volume of entrapped air for this scenario was relatively small, the one-phase ISPH model used in this study was able to capture the peak pressure characteristics, including the peak pressure amplitudes. However, in scenarios with significantly highly entrapped air during impact, a two-phase model would be necessary.