Difficulty in lowering high blood pressure is generally considered to be recalcitrant hypertension, which may be due to pseudo-refractory hypertension, failure to obtain effective improvement in lifestyle, and irrational antihypertensive treatment regimen. Recalcitrant hypertension, also known as refractory hypertension, is defined as a failure to achieve the target level of blood pressure despite treatment with a combination of three or more antihypertensive medications in the appropriate dosage (which should generally include a diuretic). The use of four or more antihypertensive medications should also be considered as recalcitrant hypertension, although blood pressure is at target. It may be associated with the following factors: 1. False intractable hypertension: the illusion of high blood pressure measurements due to incorrect blood pressure measurements, the “white coat phenomenon”, or poor treatment adherence. 2. Lifestyle not effectively improved: for example, weight and salt intake not effectively controlled, excessive alcohol consumption, not quitting smoking and so on, resulting in difficult to control blood pressure. 3. Unreasonable antihypertensive treatment program: the use of unreasonable combined treatment program. The use of antihypertensive drugs that have obvious adverse effects on some patients makes it impossible to increase the dose to improve efficacy and compliance. Diuretics are not included in the multi-drug combination program. 4. Other causes: Insulin resistance, secondary hypertension (e.g., renal artery stenosis and primary aldosteronism) are also common. The management of recalcitrant hypertension should be based on the assessment of the above possible causes, effective lifestyle intervention, rationalization of antihypertensive regimen, except for secondary hypertension, and increased patient compliance, and most patients’ blood pressure can be controlled.