Clinical practice varies regarding the choice of agent to treat hypertensive emergencies. With the development of national guidelines, a standardized pharmacotherapeutic approach would be recommended on the basis of evidence in the published literature. Such an approach might decrease the variability among practitioners and institutions in the treatment of hypertensive emergencies. Each available agent to treat hypertensive emergencies possesses both positive and negative attributes. With several intravenous, short-acting, agents available, clinicians must make educated decisions about the best medication for their patients, and these decisions should be based on organ function as well as the patient's clinical presentation. The primary goal in hypertensive emergencies is to rapidly and safely reduce blood pressure to prevent further end-organ damage. Critical care nurses have an important role in the safe and effective management of these patients. The application of knowledge of treatment goals, hemodynamic monitoring, and pharmacological therapy for hypertensive emergencies can lead to the safe recovery of these critically ill patients.