Hypertension grade 3, also called severe hypertension, is defined as blood pressure with a systolic blood pressure ≥ 180 mmHg and/or a diastolic blood pressure ≥ 110 mmHg. Patients with hypertension grade 3 who are not associated with other risk factors have a risk stratification of high risk. Patients are at very high risk if they are accompanied by more than one risk factor, or if they have target organ damage, clinical complications, or comorbid diabetes mellitus, so patients with hypertension grade 3 have a risk stratification of at least high risk. Hypertension grade 3 requires aggressive antihypertensive treatment with a combination of clinical first-line antihypertensive drugs with different antihypertensive mechanisms to keep blood pressure in the target range for a long time, and active lifestyle interventions to control other cardiovascular risk factors while lowering blood pressure.