An acute elevation of blood pressure (BP) greater than 180/120 mm Hg associated with target organ damage is considered a hypertensive emergency. Patients with a hypertensive emergency need intravenous medications and close monitoring in the intensive care unit. Whereas an acute elevation of BP greater than 180/120 mm Hg without evidence of target organ damage is a hypertensive urgency. Patients with a hypertensive urgency are treated with oral medications and generally discharged home with outpatient follow-up. Patients with either condition need a thorough evaluation to determine cause of the acute increase in BP and education to optimize the treatment regimen long-term.