Resistant hypertension is defined as blood pressure that remains above therapeutic goals despite the use of at least three antihypertensive agents from different classes, including a diuretic, at maximum or maximally tolerated doses. It is also diagnosed if blood pressure control requires four or more antihypertensive drugs. Diagnosis involves excluding apparent treatment-resistant hypertension, which is often due to non-adherence. Resistant hypertension is associated with significant cardiovascular events, including heart failure, ischemic heart disease, stroke, and renal failure. Guidelines recommend lifestyle modifications and antihypertensive medications, typically including an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, a calcium channel blocker, and a long-acting thiazide-type diuretic. If a fourth drug is needed, a mineralocorticoid receptor antagonist is supported by evidence. Several novel agents, such as aldosterone synthase inhibitors and dual endothelin receptor antagonists, are under development. Device-based approaches, particularly renal denervation, have shown promise in controlling hypertension. The review covers the diagnosis, evaluation, and management of resistant hypertension, emphasizing the importance of accurate blood pressure measurements, assessing non-adherence, and screening for secondary causes. It also discusses the latest treatments, including new drugs and devices, and provides guidelines for managing resistant hypertension.Resistant hypertension is defined as blood pressure that remains above therapeutic goals despite the use of at least three antihypertensive agents from different classes, including a diuretic, at maximum or maximally tolerated doses. It is also diagnosed if blood pressure control requires four or more antihypertensive drugs. Diagnosis involves excluding apparent treatment-resistant hypertension, which is often due to non-adherence. Resistant hypertension is associated with significant cardiovascular events, including heart failure, ischemic heart disease, stroke, and renal failure. Guidelines recommend lifestyle modifications and antihypertensive medications, typically including an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, a calcium channel blocker, and a long-acting thiazide-type diuretic. If a fourth drug is needed, a mineralocorticoid receptor antagonist is supported by evidence. Several novel agents, such as aldosterone synthase inhibitors and dual endothelin receptor antagonists, are under development. Device-based approaches, particularly renal denervation, have shown promise in controlling hypertension. The review covers the diagnosis, evaluation, and management of resistant hypertension, emphasizing the importance of accurate blood pressure measurements, assessing non-adherence, and screening for secondary causes. It also discusses the latest treatments, including new drugs and devices, and provides guidelines for managing resistant hypertension.