Oral clonidine hydrochloride rapid titration or loading is a safe, effective method to control severe elevations of blood pressure in hypertensive crisis in many clinical situations. An initial oral dose of 0.1 to 0.2 mg of clonidine hydrochloride followed by hourly doses of 0.05 or 0.1 mg until goal blood pressure is attained that does not reduce perfusion to critical organs, or a total of 0.7 mg is given, will achieve a significant reduction in blood pressure in 93% of patients. A smooth, rapid, predictable reduction in blood pressure, patient comfort, lower overall cost, reduced requirement for close observation, intravenous lines, and hospitalization, and a small incidence of clinically significant side effects make oral clonidine rapid titration an attractive oral antihypertensive agent for patients with hypertensive urgencies and in some carefully selected patients with hypertensive emergencies. Immediate outpatient follow-up within 24 hours is mandatory in all patients who are not hospitalized to adjust the dose of antihypertensive medications.