Introduction: Hypertensive crisis defines as a sudden rise in blood pressure that can adversely affect the vital organs. As such, it is recommended to take midazolam to lower the blood pressure in patients of hypertensive crisis. This study aims to investigate the midazolam efficacy as an emergency care to control the blood pressure in patients diagnosed with hypertensive crisis. Methods The current paper represents a double-blinded clinical trial study that examines the patients of the hypertensive crisis who referred to Imam Hossein Hospital of Shahroud, 2018. Patients with systolic/diastolic blood pressure greater than 180/110 mm Hg and with healthy vital organs were selected randomly and divided into three groups of 43 participants. All patients’ blood pressure in both arms, and after a period of 10 minutes in the left arm, was checked and was checked again after administering the medication for 4 times of 15 minutes till 1 hour complete. IBM SPSS Amos 23 was implemented. One-way ANOVA, Chi-Square and Repeated measure tests were performed to carry out statistical analysis. The level of significance of 0.05 was considered. Results in the group of midazolam, it was observed a reduction of 20.6% (P = 0.024), 17.4% (P = 0.001), and 19.1% (P = 0.009) for the systolic blood pressure, diastolic blood pressure, and blood pressure average, respectively. In such case, it was also indicated to be a significant difference of the reduction before and after the treatment. The group of captopril showed a decrease of 19.9% (P = 0.001), 13.5% (P = 0.008), and 16.7% (P = 0.001) for the systolic blood pressure, diastolic blood pressure, and blood pressure average, respectively. It was also observed to be a significant difference in reducing the blood pressure before and after the treatment. The group of midazolam and captopril showed the greatest reduction of blood pressure before, in the middle, and after carrying out the treatment methods. As such, systolic blood pressure, diastolic blood pressure, and the blood pressure average changed to the reduction of 23.5% (P = 0.047), 17.4% (P = 0.021), and 20.5% (P = 0.031), respectively. No significant difference was observed among these three groups (P = 0.239).