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Resistant or difficult-to-treat hypertension is an increasingly common clinical problem. Such patients are at increased cardiovascular risk compared to patients with more easily controlled hypertension. Causes of resistant hypertension are multifactorial, but recent studies suggest that inappropriate fluid retention and heightened sympathetic tone likely play key roles. This web focus highlights recent advances in our understanding of mechanisms and complications of resistant hypertension as well as emerging therapies for this particular disorder.