[What is confirmed in the treatment of difficult-to-control arterial hypertension?]

Resistant hypertension is defined as blood pressure remaining above the target level despite treatment with three different antihypertensive agents, including a diuretic, prescribed at maximum or maximally tolerated doses. Prior to any escalation of therapy, the existing standard treatment should be optimized and simplified. In addition to the use of a potent diuretic, reducing potential barriers to adherence is particularly important due to the high prevalence of non-adherence. The simpler the medication regimen is structured, the more likely patient adherence can be positively influenced. National and international guidelines recommend spironolactone as the fourth-line antihypertensive agent. In cases of intolerance or contraindications, alternative pharmacological options with a lower level of evidence are available. For selected patient groups, interventional procedures may also be considered. Decisions regarding such interventions should be made within the framework of comprehensive patient counseling and shared decision-making in specialized centers.