Abstract : The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) divides hypertensive crisis into hypertensive emergency and hypertensive urgency. Hypertensive urgency is a severe elevation in blood pressure without progressive target organ damage. The drugs, labetalol and hydralazine are usually administered for hypertensive urgency in emergency room, but a head to head comparison on efficacy of each drug has not been reported so far. In this study, efficacy of labetalol and hydralazine compared along with requirement of second dose of each drug in patients presenting to emergency room with hypertensive urgency. A prospective observational study was conducted in 100 patients, presented with hypertensive urgency in emergency room during the time period from August 2019 to July 2020, after fulfilling both inclusion and exclusion criteria. Efficacy of both drugs were compared by measuring systolic blood pressure, that is one hour after administering each drug. Percentage of decrease in systolic BP after administering labetalol was 18.98± 9.55% and that of hydralazine was 21.32± 8.08% (P value=0.039). Hence this study revealed that hydralazine is more efficacious than labetalol in systolic BP reduction. Second dose required for 15(28.3%) patients in labetalol group and that of hydralazine was only 10(21.3%) (P value=0.418) The result of the study shows that, both hydralazine and labetalol are effective (JNC-7 guidelines) and safe in hypertensive urgency. But on comparison, it is found that hydralazine is having an edge over labetalol in treating hypertensive urgency.