Background The steps and goals of treatment of hypertensive urgencies in the emergency department are not clear. The aim of this study was to compare the risk of revisits with elevated blood pressure in hypertensive urgency patients in the emergency department managed with and without oral antihypertensive medications. Methods This retrospective cohort study was conducted at the Emergency Medicine Department of Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand, from January 2018 to April 2020. A total of 692 hypertensive urgency patients were enrolled and categorized into oral antihypertensive drugs group and no oral antihypertensive drugs group. Results There were 298 patients in the antihypertensive drugs group and 394 patients in the no antihypertensive drugs group. There were no statistically significant differences of revisit rate with elevated blood pressure between oral antihypertensive drugs group and no antihypertensive drugs group within 1 day (4.36% vs 6.35%, P =0.313) and 7 days (32.55% vs 31.22%, P =0.742). The risk of revisits with elevated blood pressure was similar in both groups at 1 day (OR=0.58, 95% CI=0.26–1.27) and 7 days (OR=1.11, 95% CI=0.77–1.61). We found no case of major adverse cardiovascular events (MACE) in 1 day and a similar risk of MACE in 7 days (OR=0.23, 95% CI=0.01–4.18). Blood pressure control within 2 weeks was also not different (OR=0.76, 95% CI=0.45–1.30). Conclusion We have found no obvious evidence of benefit from oral antihypertensive agents in managing hypertensive urgencies in the ED. Oral hypertensive agents had no benefit in the reduction of blood pressure, no effect on reduction of ED length of stay, and blood pressure control within 2 weeks.