Hypertension is one of the most common medical problems that affects approximately 1 billion individuals worldwide. Hypertension also results in significant morbidities despite the availability of antihypertensive medications. Severe hypertension usually develops in individuals with chronic hypertension but may also occur in individuals with no previous elevation of blood pressure. Patients with severe hypertension may present to their primary care physician with relatively mild symptoms or to the emergency department or intensive care unit (ICU) with life-threatening complications. Some patients can be managed in the outpatient setting but others require hospitalisation on the general ward, an intermediate care unit, or the ICU. Appropriate evaluation and management of patients with severe hypertension is important because inadequate therapy as well as overaggressive therapy can result in adverse consequences.