Management of Hyperosmolar Hyperglycemic State (HHS) with coexisting hypertension is a medical emergency requiring urgent, multidisciplinary care and immediate hospitalization. Treatment focuses on aggressive intravenous fluid resuscitation, careful electrolyte replacement—particularly potassium—and lowdose insulin therapy to gradually reduce hyperglycemia while minimizing the risk of cerebral edema. Concurrently, underlying precipitating factors, most commonly infection, must be identified and treated. Preventive measures against complications such as thromboembolism, including prophylactic heparin, are also essential in the absence of hemorrhagic stroke.