Background: Severe hypertension in pregnancy is associated with adverse maternal, fetal and perinatal outcomes. Both intravenous labetalol and hydralazine are useful for emergency treatment of severe hypertension in pregnancy. However, available evidence remains inconclusive regarding which of these antihypertensives is superior to the other largely due to insufficient data. Aim: To compare the efficacy and safety of intravenous hydralazine with intravenous labetalol for acute control of severe hypertension in pregnancy at University of Ilorin Teaching Hospital. Methods:The study was a randomized controlled trial involving 160 pregnant women who presented with severe hypertension at University of Ilorin Teaching Hospital and were randomized to receive either intravenous hydralazine or intravenous labetatlol. Patient selection was by purposive non probability sampling based on the set inclusion and exclusion criteria. The primary outcomes were the minimum number of doses and time taken to achieve blood pressure control. While the secondary outcomes were the rate of persistent hypertension, adverse effects of the drugs, maternal and perinatal outcomes. The data was analyzed using the statistical package for social sciences software (IBM SPSS Statistics) version 23.0 and level of statistical significance was set at p< 0.05.