Objective: • Characterise patients admitted to the Coronary Care Unit with hypertensive emergency. • Analyse the reasons leading to hospitalisation. • Evaluate treatment and discharge diagnosis. Methodology A single-centre longitudinal prospective registry was conducted, including patients admitted to the Coronary Care Unit of the Spanish Hospital of Mendoza with a diagnosis of hypertensive emergency, from May 1, 2022, to April 30, 2024. Age, gender, pre-discharge treatment, cardiovascular risk, pre-existing diagnosis of hypertension, quantity and type of medications at admission, quantity and type of medications at discharge, presence of target organ damage, and diagnosis of secondary hypertension were recorded. Statistical analysis was performed using JAMOVI. Results: Fifty-nine patients with hypertensive emergency were admitted, 61% of whom were women. Sixty-four percent had a prior diagnosis of hypertension. Of these, 72% had no treatment at admission, 12% were on monotherapy, and 10% were on dual therapy. Only 10% of patients on combination therapy had preferred combination therapy. Twenty-five percent had low cardiovascular risk, 42% moderate, 25% high, and 6% very high. Fifty-four percent were diagnosed with target organ damage. Secondary causes were found in 31.5% of patients, including gestational hypertension or preeclampsia (19%), primary hyperaldosteronism (7%), renovascular hypertension (3%), and pheochromocytoma (2%). The mean number of medications at admission was 0.64 (CI=0.52,0.76) and at discharge was 2.90 (CI: 2.72,3.24). All were preferred combinations. No re-admissions were recorded during the 2-year follow-up. Conclusions: According to the data, non-adherence and medical inertia were the most frequent causes of hospitalisation for hypertensive emergency. Only 12% of patients had a diagnosis of secondary hypertension, and 19% of admissions were related to pregnancy. However, it is noteworthy that more than half of the patients had target organ damage, reclassifying patients at higher cardiovascular risk. Following guidelines and using preferred combinations controlled cardiovascular events 100% during follow-up.