The article reviews contemporary data regarding resistant arterial hypertension. Successful treatment of resistant hypertension requires the identification and correction of reversible risk factors and causes of secondary hypertension. Recommendations for the pharmacological treatment of resistant hypertension remain largely empiric due to the lack of systematic assessment of 3- or 4-drug combinations. Special attention is paid not only to the choice of effective drugs at optimal doses, but their rational combinations. Prior benefit, history of adverse events, concomitant disease processes, and financial reasons should be also taken into account. A triple drug regimen of an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, calcium channel blocker, and a diuretic is effective and well tolerated. This triple regimen can be accomplished with two pills containing various fixed-dose combinations. Taking into account the pathogenetic mechanisms of formation of resistant hypertension, comorbidities, neurohumoral profile, metabolic effects of drugs and the selection of their optimal combinations, there is need in new approaches to combination antihypertensive therapy.