Introduction: Resistant hypertension (HT) is a common clinical entity with debilitating cardiovascular
consequences. The highly heterogeneous nature of resistant HT requires a meticulous workup
to exclude ‘pseudo-resistance’ and secondary forms of arterial HT. Resistant HT has recently gained
wide scientific interest due to the introduction of interventional methods (renal sympathetic denervation
and carotid baroreceptor stimulation) for blood pressure (BP) reduction in this patient population. Despite
however the recent advances in understanding the pathophysiology and the clinical characteristics
of the disease, the appropriate management of resistant HT remains elusive. The marked heterogeneity
of BP response to interventional therapy underlines the need for careful patient selection and the identification
of ideal candidates for interventional therapy.
Conclusion: The renin-angiotensin-aldosterone system seems to play a cardinal role in the pathophysiology
of resistant HT and requires appropriate management. Furthermore, primary aldosteronism is
considered the most common form of secondary HT, with increased prevalence in patients with resistant
HT. This review aims to provide a simplified work-up for patients with resistant HT, summarize the
rationale for the determination of renin and aldosterone levels, and critically discuss available evidence
on when and how to measure renin/aldosterone in resistant HT.