Arterial hypertension is the most common illness affecting approximately 1 billion people worldwide. 1–2% of these group of people will develop hypertensive crisis during their lives. Hypertensive crisis is defined as the elevation of systolic blood pressure > 180 mmHg or diastolic blood pressure > 120 mmHg and can be divided into hypertensive emergencies and hypertensive urgencies. In this article treatment recommendations for the most common acute cardiovascular syndromes are discussed, including cardiogenic pulmonary edema, acute ischemic stroke, acute coronary syndrome, hypertensive encephalopathy, acute aortic dissection and intoxications caused by psychoactive substances. The priority in the treatment of hypertensive crisis is to reduce blood pressure over minutes to hours with intravenous medications. More aggressive lowering of blood pressure is acceptable in the case of acute aortic dissection. On the other hand, a too rapid reduction of blood pressure may lead to the damage of vital organs. Therefore, it is very important to reduce blood pressure in a controlled manner.