根據衛生福利部統計，高血壓疾病為國人十大死因之一。同時高血壓亦為其他疾病如心臟血管疾病、腦血管疾病及腎臟疾病等的危險因子。在罹患高血壓的病人族群中，根據統計約有10-15%的病人屬於頑固性高血壓(Resistant Hypertension)。頑固性高血壓的定義為使用三種以上的抗血壓藥物(Anti-hypertensive Drug)，每種抗血壓藥物為最大劑量或可忍受之最大劑量且其中一種抗血壓藥物必須為足量的利尿劑或使用四種抗血壓藥物，病人的血壓依然高於140/90 mmHg或高危險族群依然高於130/80 mmHg稱之為頑固性高血壓。相較於其他血壓控制良好的病人，此類病人具有較大的心血管疾病及標的器官受損風險。治療上除了藥物使用外，病人生活型態調整、避免造成高血壓藥物及病人對於抗高血壓藥物的正確認知及順服性都會影響治療效果。近幾年，腎動脈交感神經燒灼術(Renal Sympathetic Denervation)提供了另一種除藥物外治療高血壓的選擇；但根據最近的Symplicity HTN-3結果顯示跟無真正執行燒灼術治療(sham procedure)方式相比，腎動脈交感神經燒灼術治療並不能更有效地降低血壓；因此腎動脈交感神經燒灼術的效果仍需其他長時間及大規模的研究加以確認。本文主要將對目前對於頑固性高血壓的盛行率及相關處置進行相關的探討。

According to the recent report by Ministry of Health and Welfare in Taiwan, the hypertensive heart disease is still one of the top ten causes of death. Besides, hypertension is also a major risk factor for many diseases, including cardiovascular disease, cerebrovascular disease and renal disease. Among the hypertensive population, 10-15% patients have resistant hypertension (RH). The definition of resistant hypertension is blood pressure more than 140/90 mmHg after maximal or tolerable doses of three or more anti-hypertensive drugs treatment, including at least one adequate dose of diuretic. These RH patients have higher risk of cardiovascular disease and target organ damage. In addition to use of anti-hypertensive medication, lifestyle modification and avoiding drugs causing hypertension, good compliance for anti-hypertensive drug use are also important factors for hypertension therapy. Recently, renal sympathetic denervation provides another treatment option for RH. However, its efficacy is questioned by recent Symplicity HTN-3 trial. This article discusses the current prevalence and management strategy for RH. (J Intern Med Taiwan 2014; 25: 231-237)