Resistant hypertension is a common medical disorder. Resistant hypertension is defined as failure to achieve goal blood pressure despite adherence to treatment of full or adequate doses of at least 3 antihypertensive medications, including a diuretic or controlled to goal on >4 antihypertensive medications. The exact prevalence of resistant hypertension is unknown. It is estimatd that the prevalence of resistant hypention ranged from 5 to 30% of the overll hypertenion population. Patients with resistant hypertension have greater target end-organ damage and a higher long-term cardiovascular risk compared to patients with controlled hypertension.
　　Patients with resistant hypertension should routinely be encouraged to reduce sodium intake, lose weight, engage in moderate exercise, and reduce alcohol intake. A generally useful strategy to optimize blood pressure is to combine agents from various classes, each of which has one or more of the following effects: a reduction in volume overload (diuretics and aldosterone antagonist), a reduction in sympathetic overactivity (b-blockers), a decrease in vascular resistance (ACE inhibitors or angiotensin-receptor blockers), the promotion of smooth-muscle relaxation (dihydropyridine calcium-channel blockers). A high prevalence of aldosterone excess has been found in patients with resistant hypertension. Low dose of spironolactone or eplerenone can be an excellent antihypertensive drug for management of resistant hypertension.
　　The sympathetic nervous system plays an important role in resistant hypertension. Renal denervation and baroreflex activation therapy have been shown to reduce central sympathetic drive. Renal denervation and baroreflex activation therapy are used in clinical practice for severe treatment resistant hypertension in some countries. Symplicity HTN-1 and 2 trials demonstrated significantly reduced office blood pressure in resistant hypertension patients receiving renal nerve denervation. However, in Symplicity HTN-3 trial, a controlled trial of renal denervation for resistant hypertension, the office and ambulatory blood pressure were not significantly changed in patients with renal denervation and sham control group. The Joint UK Societies does not recommend the use of renal denervation in routine clinical practice. Novel interventional approaches for resistant hypertension in early development include carotid body ablation and arteriovenous fistula placement.