This study investigates the prevalence of hypertensive urgency in elderly patients (over 80 years of age) and explores pharmacologic management approaches and clinical outcomes. Hypertensive urgency, defined as a systolic blood pressure greater than 180 mmHg or diastolic pressure greater than 120 mmHg, without end organ damage, is common in elderly populations, however limited evidence exists on prevalence, management and outcomes in elderly inpatient cohorts. A retrospective cohort study was conducted on inpatients aged 80 years or older admitted under the Geriatric Medicine service at Concord Hospital between January-June 2024. Patients with hypertensive urgency were identified by chart review of electronic medical records and stratified into two groups: those who received acute antihypertensive therapy and those who did not. The study assessed patient demographics, comorbidities, treatment, rates of hypertensive end organ damage and other clinical outcomes. From 627 individual patients, 109 (17.3%) had at least one episode of hypertensive urgency during admission. 32.1% received additional antihypertensive management. Amlodipine and transdermal nitrates were most prescribed. No significant differences were observed in end-organ damage and other clinical outcomes rates, readmission rates or 30-day mortality. Patients who received acute management had a shorter mean length of stay (11.31 days) than those managed conservatively (16.70 days; P = 0.036). Additional antihypertensive treatment of urgency did not result in different rates of end-organ damage, other clinical outcomes, readmission rates or mortality. There were potential gaps identified in formal medical documentation and consistency in treatment approaches towards hypertensive urgency in the cohort.