This comprehensive review explores the complex landscape of HPHT drilling, examining the underlying principles, innovative technologies, and operational strategies used to overcome challenges such as wellbore stability, fluid management, equipment reliability, and downhole conditions. By understanding and addressing these challenges, the oil and gas industry can advance HPHT drilling capabilities and unlock new sources of energy to meet growing global demand. High-pressure, high-temperature (HPHT) drilling techniques have become indispensable for the oil and gas industry to tap into deep hydrocarbon reservoirs located in challenging environments. Despite their significance, HPHT drilling operations pose a myriad of technological and operational challenges that demand meticulous attention to safety, efficiency, and success. This comprehensive review embarks on an exploration of the intricate landscape of HPHT drilling, delving into the fundamental principles, innovative technologies, and operational strategies pivotal in surmounting obstacles such as wellbore stability, fluid management, equipment reliability, and downhole conditions. The review begins by delineating the distinctive characteristics of HPHT environments, highlighting the formidable challenges inherent in drilling operations conducted under extreme pressures and temperatures. Subsequently, it elucidates the critical importance of maintaining wellbore stability amidst such conditions, elucidating the risks of collapse and blowouts and offering insights into mitigation strategies ranging from meticulous drilling fluid selection to advanced wellbore monitoring techniques. Fluid management emerges as a focal point, as the review navigates through the complexities of selecting, formulating, and managing drilling fluids tailored for HPHT environments. Innovative technologies such as nanotechnology applications and synthetic-based mud systems are explored for their efficacy in addressing fluid-related challenges and enhancing drilling performance. The reliability and integrity of equipment constitute another critical aspect examined in the review, with emphasis on mechanical challenges, material selection, and proactive maintenance strategies essential for safeguarding equipment performance and longevity in HPHT operations. Furthermore, the review presents case studies and best practices gleaned from successful HPHT drilling projects, offering valuable insights and lessons learned to inform future endeavors.