Background: Management of hypertension in Mozambique is poor, and rates of control are amongst the lowest in the world. Health system related factors contribute at least partially to this situation, particularly in settings where there is scarcity of resources to address the double burden of infectious and non-communicable diseases. This study aimed to assess the management of hypertension in an emergency department (ED). Methods: During a pragmatic and prospective 30-day snapshot study (with 24 hour surveillance) and random profiling of one-in-five presentations to the ED of Hospital Geral De Mavalane, Maputo, we assessed patient’s flow, infrastructure and resources through direct observation, and reports from pharmacy and laboratory stocks were used to assess availability of diagnostics and medicines needed for hypertension management. Results: Hypertensive patients had several stops during their journey inside the health facility, and followed a non-standardized flow. No clinical protocols or algorithms for risk stratification of hypertension were available. Stock-outs of basic diagnostic tools for risk stratification and medicines were registered. The availability of medicines was 28% on average. Conclusions: Critical gaps in health facility readiness to address arterial hypertension seen in ED were uncovered, including lack of clinical protocols, insufficient availability of diagnostics and essential medicines, as well as low affordability of the families to guaranty continuum of care. Innovative financing mechanisms are needed to support the health system to address hypertension.