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Resistant hypertension is defined as blood pressure that remains higher than the target values (140/90 mmHg for the general population and 130/80 mmHg for diabetics and patients with chronic renal failure), despite the use of three antihypertensive drugs, including a diuretic to the maximum tolerated dose. “Resistant” hypertension is a clinical entity with high prevalence, in elderly patients. The concept of “pseudo-resistant” hypertension attributed to poor adherence to therapy, to use of hypertensive drugs and to an wrong lifestyle, complicate the diagnosis of “resistant” hypertension. Accurate application of guidelines of pharmacological and not pharmacological treatment of hypertension and the use of devices (i.e., renal denervation and stimulation of the carotid sinus) represent tools to counteract “resistant” hypertension which is often characterized by a poor prognosis, especially in elderly patients.