Refractory hypertension is one of the more difficult groups of clinical hypertension treatment, refractory hypertension needs to be screened for causes, many secondary hypertension primary causes are more serious than the hypertension itself, if the causes of refractory hypertension are clear, there may be a clear direction of treatment for many problems, the treatment for the cause is also more effective. 1, blood pressure “refractory” is not false? To determine if you have pseudo-intractable hypertension (1) Is your blood pressure measured correctly? Incorrect blood pressure measurement is a common cause of pseudo-refractory hypertension. For example, a patient’s unsupported back can raise diastolic blood pressure by 6 mm Hg and crossed legs can raise systolic blood pressure by 2-8 mm Hg. Not using a larger cuff and taking only 1 blood pressure measurement in those with thicker upper arms are also important causes. In addition, in some older adults, cuff inflation has exceeded the actual level of systolic blood pressure due to calcification and thickening of the radial artery. All of the above measurement errors may result in pseudohypertension. (2) Is the patient taking antihypertensive medication? Some patients believe that the side effects of antihypertensive drugs are too great and they resist taking them. Although this part of the patient’s hypertension appears “difficult to treat”, but in fact, as long as the antihypertensive drugs are taken on time, they will be controlled. (3) Is it “white coat hypertension”? When they see the “white coat”, they get nervous and excited, and their blood pressure spikes, showing the illusion of hypertension, but in fact it is not as difficult to treat as they think, or they do not have hypertension at all. (4) Did you take the medication that raises high blood pressure? Drugs that interfere with the antihypertensive effect usually include: non-steroidal anti-inflammatory drugs (which can block the antihypertensive effect of several drugs such as diuretics, ACEI, ARB and beta-blockers), oral contraceptives, caffeine, diet pills, mephedrone, . Cyclosporine A, erythropoietin, glucocorticoids, cocaine, licorice, ephedra, etc. 2, after the discharge of these above artifacts, the patient is indeed very high blood pressure, difficult to reduce, to trace the cause of hypertension. Usually refractory hypertension for secondary hypertension, find the cause of hypertension, remove the cause, it is possible to control the blood pressure. Secondary hypertension involves a wide range of systemic diseases, including neuroendocrine causes, renal parenchymal disease, primary aldosteronism, renal artery stenosis, progressive renal insufficiency, polycystic ovaries, etc. The pathological mechanism is very complex and is the focus of attention in the prevention and treatment of hypertension. If a patient has a history of hypertension and the blood pressure is not lowered for a long time, in addition to the aforementioned pseudo-factors, the primary cause of the elevated blood pressure needs to be thoroughly investigated. Sometimes hypertension may be a protective mechanism of the body, and if one blindly lowers the blood pressure, it may cause more serious consequences. This also reflects the importance of treating the cause of the disease. It is recommended that patients with refractory hypertension be screened and treated at a regular specialized hypertension specialist or cardiology department, with a view to treating the underlying cause.