Hypertensive crisis occurs when critically elevated blood pressure is accompanied by diastolic pressure greater than 120 to 130 mm Hg. The presence of acute or ongoing end-organ damage constitutes a hypertensive emergency, which requires reduction of blood pressure within minutes to hours to avoid catastrophic outcomes. Critically elevated blood pressure without end-organ damage is known as a hypertensive urgency, which is generally treated over 24 to 48 hours in a closely monitored outpatient setting. Although hypertensive crises are relatively rare, most primary care physicians will eventually encounter them. Thus, for optimal patient outcomes, it is important to be aware of appropriate treatment options as well as the impact of potential complications on management.