Resistant Hypertension refers to blood pressure that remains above target despite the use of three or more antihypertensive medications of different classes at optimal doses, ideally including a diuretic. As cardiovascular disease continues to be the leading global cause of morbidity and mortality, clinicians increasingly explore targeted learning on this topic during specialised cardiology conference sessions to refine diagnostic evaluation, treatment escalation and long-term risk reduction strategies. Because sustained, uncontrolled blood pressure dramatically heightens the likelihood of stroke, heart failure, kidney disease and vascular complications, the ability to distinguish true resistance from secondary causes, poor adherence or measurement errors is a core component of effective advanced blood-pressure management.

The session begins by clarifying definitions. True resistant hypertension is distinguished from pseudo-resistance, which may arise from white-coat effect, incorrect cuff size, improper measurement technique or inconsistent home monitoring practices. Participants also review how medication adherence, lifestyle contributors and drug interactions influence apparent treatment failure. By systematically evaluating these elements, clinicians can identify reversible contributors long before intensifying therapy unnecessarily.

Secondary hypertension is emphasised as a major cause of resistance. Conditions such as primary aldosteronism, renal parenchymal disease, renal artery stenosis, obstructive sleep apnea, pheochromocytoma and endocrine disorders significantly affect blood-pressure control. Participants explore structured diagnostic workups, including aldosterone–renin ratio interpretation, renal imaging, sleep-study indications, biochemical testing and referral pathways to subspecialists. Case discussions highlight how common secondary causes are often missed without an organised assessment framework.

Therapeutic strategies form the core of this session. Evidence-based escalation includes optimising diuretic therapy—switching to chlorthalidone, adding loop diuretics for chronic kidney disease, or incorporating mineralocorticoid receptor antagonists for suspected aldosteronism. Newer agents, fixed-dose combinations and long-acting formulations are reviewed for their benefits in adherence, tolerability and simplification of complex regimens. For selected patients, device-based or procedural therapies such as renal denervation and baroreflex-activation systems are discussed, alongside ongoing trial data and considerations for real-world implementation.

Lifestyle interventions remain essential. Clinicians examine the impact of sodium intake, obesity, sedentary behaviour, excess alcohol consumption, psychosocial stress and sleep quality. Practical tools, including motivational interviewing, digital monitoring and multidisciplinary coaching, are reviewed for improving patient participation. Participants also discuss managing resistant hypertension in special populations, including older adults, individuals with CKD, pregnant patients and those with multiple comorbidities.

Future directions highlight precision medicine, pharmacogenomics, wearable hemodynamic sensors and AI-assisted prediction models that identify early risk for resistance. By the end of the session, clinicians will be equipped with a structured, comprehensive strategy for evaluating and treating resistant hypertension, ensuring that therapy is targeted, efficient and aligned with evolving guidelines. The overarching objective is to transform complex blood-pressure challenges into manageable clinical pathways supported by strong evidence and thoughtful patient engagement.