Refractory hypertension, also known as intractable hypertension, is a condition in which systolic and diastolic blood pressure cannot be controlled at target levels or at least four drugs are required to lower blood pressure despite the possibility of controlling systolic and diastolic blood pressure at target levels with the application of lifestyle improvement and at least three adequate antihypertensive drugs, including diuretics, in reasonable combinations. Refractory hypertension has multiple causes, including poor patient compliance, various exogenous factors, and secondary hypertension. Among them, aortitis, as one of the more common vascular diseases, should attract sufficient attention from our clinicians. Concept and epidemiology Aortitis is a chronic progressive nonspecific inflammatory lesion of the aorta and its major branches, which can cause stenosis or occlusion at different sites, and in a few patients, arterial dilatation or aneurysm due to inflammation that damages the middle layer of the arterial wall. When aortitis involves the thoracoabdominal aorta and renal arteries, it can lead to refractory hypertension. Aortitis is more frequently reported in Asia, followed by South America, and is rare in Western Europe, with a male to female incidence ratio of 1:2.8 and 90% of cases occurring within 30 years of age. A few patients may experience general malaise, easy fatigue, fever, loss of appetite, nausea, sweating, weight loss and menstrual irregularities several weeks before the appearance of local symptoms or signs. Typing and diagnostic criteria The typing proposed by Lupi-Herrea et al. in 1977 is simple and practical, in line with Chinese conditions, and is still widely used. It is divided into type I (cephalobrachial artery type), type II (thoracic and abdominal aorta type), type III (mixed type), and type IV (both pulmonary artery type) according to the lesion site. After comparing and analyzing the clinical manifestations and angiographic examinations of 700 cases of aortitis, Professor Zheng Deyu of Fu Wai Hospital and others proposed the diagnostic criteria of aortitis in China: (1) age of onset ≤ 40 years; (2) stenosis or occlusion of the subclavian artery, weak or no pulse, systolic pressure difference >10 mmHg in the upper limbs bilaterally, and murmur heard on the clavicle; (3) stenosis or occlusion of the carotid artery, weakened pulsation of the carotid artery (3) carotid artery stenosis or occlusion, weak or absent carotid pulsation, vascular murmur in the neck or fundus changes in aortitis; (4) thoracic and abdominal aortic stenosis, vascular murmur in the epigastrium or back, systolic pressure in the lower extremities increased by 40mm/h compared to the upper extremities, prednisone 30-60mg or 1mg/kg daily, maintain for 4-6 weeks and then gradually reduce the dose, with no increase in blood sedimentation as the indicator of reduction, the dose can be maintained for 3-6 months when reduced to 5-10mg daily. The dose can be reduced to 5~10mg daily for 3~6 months. If prednisone is not effective, dexamethasone can be used instead. If immunosuppressive drugs do not respond well to hormones, azathioprine, cyclophosphamide or 6-thiopurine may be used in combination. In stable patients, dilation, improvement of microcirculation and anticoagulant drugs should be given: these include trimethoprim, aspirin and pentoxifylline. Anti-hypertensive drugs are generally ineffective antihypertensive drugs. ACEI can be applied in unilateral renal artery stenosis without indications for surgery or dilation, but changes in renal function should be closely observed. Interventional treatment should be preferred for patients with limited and severe stenosis of the artery that leads to ischemia in the heart, brain, kidney and corresponding parts of the limbs, if interventional treatment is indicated.