Hypertension is the most common medical co morbidity encountered in a perioperative patient. It often causes a dilemma in management and results in postponement of surgery. Although the consequences of uncontrolled hypertension have significant adverse out come in a surgical patient, there are no national guidelines or protocols on how to manage such a situation. Having a clear understanding about the evaluation of such patients; target blood pressure levels; selection and timing of appropriate antihypertensive medication would improve the outcome of these patients. This review article would focus on a practical guide to the clinicians in evaluating and managing a patient with perioperative hypertension in a Sri Lankan setting.