Refractory hypertension is defined as a condition in which blood pressure cannot be controlled at the target level even after the application of at least three antihypertensive drugs of different mechanisms, including diuretics, in sufficient doses and courses, or at least four drugs are required to achieve blood pressure control. Patients with refractory hypertension often have a combination of multiple cardiovascular risk factors and severe target organ damage. If blood pressure is not effectively controlled over time, the risk of cardiovascular disease will be further increased. After the diagnosis of refractory hypertension, we need to reconsider the following four aspects: 1) whether lifestyle interventions have been intensified; 2) whether “white coat” hypertension has been ruled out; 3) whether secondary hypertension has been comprehensively screened; 4) whether acute attacks of cardiovascular and cerebrovascular diseases have been controlled. In terms of antihypertensive drugs, we emphasize the proper use of diuretics. It is recommended that when the blood pressure control is not satisfactory with two reasonably matched antihypertensive drug regimens, the third antihypertensive drug is preferably a diuretic. The combination of “beta-blocker + RAAS blocker + diuretic” is recommended for young and middle-aged patients with refractory hypertension, while the combination of “calcium antagonist + RAAS blocker + diuretic” is recommended for elderly patients with refractory hypertension. Although thiazide/thiazide-like diuretics have adverse effects on blood glucose, blood lipids and blood uric acid metabolism, the reduction of blood pressure level can partially offset the above side effects; at the same time, we believe that even for refractory hypertensive patients, the use of diuretics in small doses is recommended, striving to “At the same time, we believe that even in refractory hypertensive patients, the use of diuretics in small doses is recommended, and we strive to maximize the efficacy of antihypertensive therapy and minimize adverse effects.