This chapter explores the definitions, risk factors, pathophysiology, workup, treatment goals, and approaches for hypertensive crises. Hypertensive emergencies, characterized by severe blood pressure elevations leading to target-organ dysfunction, are relatively rare but necessitate intensive care. While heterogeneity exists in the presentation, there is often a unifying pathophysiology which involves autoregulatory failure leading to vascular damage, micro-thrombosis, and organ dysfunction. The workup for hypertensive emergencies involves extensive laboratory and diagnostic evaluations tailored to detect underlying compelling conditions. Treatment goals vary based on the presence of compelling conditions, emphasizing controlled blood pressure reduction. Limited clinical trial evidence prompts discussions on the efficacy of definitions and stratification, challenging the urgency of care for isolated blood pressure elevations outside of compelling conditions. The treatment approach involves preparation, addressing confounding elements, and selecting appropriate antihypertensive agents. While lacking prospective trials, consensus-driven strategies prioritize controlled reduction, favoring continuous intravenous infusions for smooth blood pressure control. Dihydropyridine calcium channel blockers, direct vasodilators, and adrenergic antagonists are discussed, each with unique considerations. Managing hypertensive emergencies requires rapid evaluation, individualized treatment, and continuous monitoring. Future directions involve improved definitions, comparative trials, real-time monitoring of other BP indices (e.g., blood pressure variability), and potential novel antihypertensive drugs. Standardizing definitions and advancing therapeutic monitoring are essential for enhancing diagnosis and treatment. The critical care pharmacist clinician plays a crucial role in optimizing patient outcomes in hypertensive emergencies.