Hypertensive crises therefore are defined as major medical complications that manifest by sharp elevations of blood pressure that actually precipitate acute target organ dysfunction. So, it is necessary to manage the disease and its consequences in a proper and timely manner. There are many antihypertensive agents for acutely managing hypertensive patients, however, there is no clear consensus regarding the ideal choice of drug, its efficacy or the safety in specific settings. The objective of this study was to evaluate the effectiveness and side effects of three widely prescribed ANT agents; labetalol, nitroglycerin and Hydralazine in the management of hypertensive emergency in emergency department of Hayatabad Medical Complex Peshawar. In the next prospective, noninterventional study, patient data were collected from patients with hypertensive crisis from January 2022 to June 2023 which included 450 patients. One of the three antihypertensive agents was given to the patients depending on the assessment. The main dependent factor was the change in the systolic and diastolic blood pressure after the use of the study massage within half an hour. Secondary objectives were side effects and receiving the goal blood pressure. Data analyses used were ANOVA and t-test and the alpha level of significance set at 0. 05 considered statistically significant. Because of its efficacy in achieving target pressure in shortest time than any drug in the three arms of the study, the mean reduction of systolic and diastolic blood pressure was also the highest for Labetalol within 30 minutes being 40 /20 mmHg respectively. Moderate effectiveness was observed in nitroglycerin and least effectiveness was found in hydralazine with mean systolic reduction of about 30mmHg. Finally, on the comparison of substantial side effects, it was shown that Labetalol has the slightest percentages of the effect (Only 5% of the patients complained of dizziness) while hydralazine revealed the highest percentages of effect (Twelve percent of the patients indicated tachycardia). In hypertensive emergency, the ideal drug revealed to be labetalol as it did not cause significant complications. These results attest for its utilization in the first line of management in the emergency department with nitroglycerin and hydrohalotized as second line drugs.