Resistant hypertension (rHTN) is a frequent problem with a high impact on cardiovascular risk. The preferred diagnostic approach is to systematically evaluate risk factors for rHTN and the presence of secondary hypertension. The follow-up of several key elements will often allow an improvement of blood pressure. Four therapeutic classes or even more are often used in these patients. Adding an aldosterone antagonist is often beneficial. Monitoring of patient compliance by electronic medication event monitoring systems can be helpful. Several new therapeutic approaches are currently in development: antagonists of the endothelin receptor and two interventional methods, carotid sinus stimulators and catheter-based renal sympathetic denervation therapy, have shown some promise.