Our clinical experience and the literature regarding anesthetic management of the hypertensive patient are reviewed. Preoperative evaluation and treatment of all hypertensive patients, regardless of their degree of lability, is recommended. For emergency surgery on an untreated hypertensive patient, control of blood pressure with nitroprusside should be attempted before an awake or rapid sequence intubation. The evaluation of hypertension, the physiology of idiopathic hypertension, and the effects of treatment are discussed.