Hypertension is frequently managed by emergency medical teams (EMTs), presenting a significant challenge for emergency medical services (EMS). The COVID-19 pandemic added complexities to EMS operations, especially in the prehospital management of hypertensive emergencies. This study evaluates the prehospital management of primary hypertension by EMTs, focusing on therapeutic actions, transport decisions, and outcomes during the COVID-19 pandemic, with the goal of identifying factors influencing EMT decision-making and optimizing EMS resource allocation. A retrospective analysis was conducted on medical records from the Bieszczady EMS operational area from April 2019 to June 2021. Data from Dispatch Order Cards and Medical Rescue Activity Cards were analyzed for 2002 cases of prehospital primary hypertension. Statistical analyses included normality tests, independent samples t-test, Pearson’s Chi-squared test, and Two-way Analysis of Variance (ANOVA), with a significance level set at p < 0.05. EMT interventions were significantly longer for patients transported to the emergency department (ED) compared to those managed on-scene (t = −22.563, p < 0.001). Patients transported to the ED showed higher systolic and diastolic blood pressure (SBP: t = −20.366, p < 0.001; DBP: t = −13.718, p < 0.001). EMTs administered more medications on-scene, suggesting effective pharmacological intervention reduced the need for hospital transport (t = 11.951, p < 0.001). Additionally, patients managed on-scene experienced a greater reduction in mean arterial pressure (t = 7.707, p < 0.001). These findings highlight the need to enhance EMT training, medication protocols, and triage strategies to improve patient outcomes and EMS resource allocation, especially during public health emergencies. Further research should explore the long-term effects of prehospital hypertension management on EMS systems.