Much of the literature that focusses on haemodynamic instability in the setting of perioperative medicine, concentrates on the management of shocked states and hypotension. It may come as a surprise to the inexperienced practitioner that the management of severe hypertension especially in the post-operative setting is an ongoing and serious problem. The widely held belief that severe perioperative hypertension is not a major issue is anachronistic. I will hopefully show the listener some clinical examples from our practice where severe hypertension created an issue for patients and how the addition of clevidipine is a necessary adjunct to therapy.