Purpose of Review <p>To review the most current recommendations regarding assessment and treatment of asymptomatic hypertension treatment in the emergency department (ED) and to provide guidance for prescribing oral antihypertensive therapy for ED providers.</p> Recent Findings <p>There are varying management strategies for the treatment of asymptomatic hypertension in the ED likely due to a lack of direct guidelines for treatment. There is an increasing body of evidence for the safety of initiating therapy to treat chronic asymptomatic hypertension in the ED. Initiation and optimization of oral antihypertensive therapy in indicated patients can be done by ED providers to enhance and expediate transition of care for patients and can ultimately aid in prevention of cardiovascular disease (CVD). This review provides guidance of when oral antihypertensive therapy can be initiated, medication options depending on the patient’s blood pressure and other concurrent medications (if applicable), as well as other factors that may influence choice of therapy are described.</p> Summary <p>Oral antihypertensive therapies can be initiated and optimized in the ED for patients with asymptomatic chronic hypertension.</p>