Perioperative hypertension has been shown to be a risk factor for the development of perioperative morbidity and mortality. The time spent outside acceptable blood pressure ranges, in a state of hypertension or hypotension, is correlated with the incidence of stroke, acute coronary syndrome, renal dysfunction, and death. The ideal perioperative treatment of hypertension would include an easily titratable agent, with fast onset and offset and minimal side effects. Several medication classes are routinely used in the operating room, including, but not limited to, beta-blockers, calcium channel blockers, nitrates, and angiotensin-converting enzyme (ACE) inhibitors.Proper treatment of chronic hypertension and continuation of chronic anti-hypertensive medications in the perioperative period has been demonstrated to improve patient outcomes. This review article will outline the importance of perioperative blood pressure management, the treatment pitfalls, and the novel medications being used in the perioperative setting.