Refractory hypertension is defined as failure to achieve blood pressure despite treatment with a combination of three or more appropriate doses of antihypertensive drugs. Three or more antihypertensive drugs, one of which needs to be a diuretic. Or the patient is on four, or more, antihypertensive medications, and although the blood pressure meets the standard, it is also called refractory hypertension. What is the reason why blood pressure is so difficult to achieve? Today we will discuss the causes of refractory hypertension. The first reason is that although patients take oral antihypertensive medication on time, they do not combine it with lifestyle and dietary improvements, and they fail to pay attention to regular work and rest, avoid straining and staying up late, and have a low salt and low fat diet. For patients who smoke, drink alcohol and have a high-salt diet, it is relatively difficult to lower blood pressure. Reason two, pseudo-refractory hypertension, often due to the patient’s weekdays at home measurement error, not regular taking antihypertensive drugs, white coat hypertension and other reasons, so that the blood pressure appears to be difficult to lower the illusion. Cause three, taking drugs that can raise blood pressure. Relatively common clinical drugs that can interfere with the fall of blood pressure are birth control pills, glucocorticoids, recombinant human erythropoietin, etc. Reason four, the choice of antihypertensive drugs is not reasonable. Although a variety of antihypertensive drugs are chosen to lower blood pressure, but forget that diuretics need to be included, or that the most suitable antihypertensive drug for the patient is not selected. Reason five, the patient suffers from hypertensive disease at the same time, there is also insulin resistance. In this case, in addition to the application of antihypertensive drugs, it is also necessary to combine the application of insulin sensitizers to be able to lower blood pressure more effectively. If the patient himself is obese, appropriate exercise to lose weight can also help to make blood pressure improve. Reason 6 is that the patient does not have primary hypertension but has elevated blood pressure due to other secondary factors, which often requires treatment of the primary disease to better bring the blood pressure down to the standard range. When developing a plan for antihypertensive treatment for a patient, try to choose one that is convenient and easy to use, and also consider the actual economic level of the patient. In some cases, although a very good drug is chosen for the patient, the patient is often unable to purchase and take the drug normally after discharge due to its high price. Only by developing a reasonable medication program can we improve the patient’s compliance with the medication.