Resistant arterial hypertension (RAH) is a common problem which both primary care clinicians and specialists have to face. While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 2.6 - 29 % of the trial participants.The diagnosis of resistant hypertension requires use of good pressure measurement technique to confirm persistently elevated blood pressure levels. Pseudo-resistance including lack of blood pressure control, poor medication and adherence or the syndrome of white coat hypertension must be excluded. Resistant hypertension is almost always multifactorial in aetiology. Successful treatment requires identification and change of lifestyle factors contributing to treatment resistance, diagnosis and appropriate treatment of secondary forms of hypertension, and use of effective multidrug regimens.