Acute hypertension in pregnancy is a severe obstetric complication that requires immediate evaluation and treatment. It can occur in the context of a variety of disorders of pregnancy and is associated with significant maternal and fetal morbidity and potential mortality. This chapter presents the spectrum of pregnancy-related hypertensive disorders frequently presenting with acute changes in blood pressure control. It covers the common presenting symptomatology, the initial steps in maternal/fetal evaluation (history, physical examination, and laboratory evaluation), and management in the obstetric triage setting. In addition, the chapter discusses other possible etiologies of acute hypertension, preeclampsia with severe features, and possible imitators of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. A complete physical examination is performed, including cardiovascular, pulmonary, abdominal, ophthalmologic, neurologic, skin, and extremity evaluation. Laboratory studies include complete blood count (CBC), creatinine, liver function tests, uric acid, lactate dehydrogenase (LDH), coagulation profile, urinalysis, and urine protein:creatinine ratio.