Hypertensive emergencies are characterized by severe elevations in blood pressure resulting in acute end-organ dysfunction. Prompt recognition, careful titration of parenteral antihypertensives, and close monitoring are essential to prevent further damage. Key learning points include distinguishing hypertensive emergencies from urgencies, identifying the affected organ systems based on clinical presentation, selecting appropriate IV agents based on the type of end-organ involvement, avoiding extremes of uncontrolled hypertension and over-reduction, and safely transitioning to oral regimens. When caring for patients with hypertensive crises, clinicians must maintain a high index of suspicion for end-organ damage, thoroughly investigate possible etiologies, initiate evidence-based management, and monitor closely for improvements or deterioration. With expertise in pharmacotherapy and attention to patient-specific factors, pharmacists play crucial roles on interprofessional teams managing hypertensive emergencies.