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Estimate the frequency of true resistant hypertension among uncontrolled hypertensive patients referred to a tertiary health care center.The study was prospective and observational. We screened all hypertensive patients, 18 years old or more treated for at least 12 months and referred for uncontrolled hypertension to Tizi-ouzou teaching hospital (hypertension unit). Resistant hypertension was defined as an office blood pressure (OBP) superior or equal to 140/90 mmHg, and 24-hour ambulatory blood pressure (ABP) superior or equal to 130/80 mmHg, despite 3 drugs including a diuretic, a renin angiotensin system blocker and a calcium channel blocker at optimal doses, for at least 4 weeks.A total of 2367 patients were included between January 2013 and April 2015. Of these, 843 had an inadequate treatment regimen (426: less than 3 drugs; 238: suboptimal doses; 179: inappropriate combinations), 364 a poor adherence to prescribed antihypertensive treatment and 202 a white coat effect. Among the 958 remaining subjects, 281 had an excessive salt intake (superior to 15 g per a day, assessed by 24-hour urine sodium), 36 had interfering medications or substances consumption, and secondary causes were documented in 468 patients (Primary aldosteronism: 204, Obstructive sleep apnea:151, Renal artery stenosis:83, other causes: 30). Finally, only 173 subjects of the initial population had a true resistant hypertension, corresponding to a prevalence of 7.3% (CI 95%: 6.3%–8.3%). The mean OBP and 24-hour ABP of these patients were 159.8 ± 22.1/ 94.4 ± 14.7 and 149.4 ± 15.5/ 89.7 ± 12.7 mmHg, respectively. Their clinical characteristics were: mean age (59.7 ± 11.6); women (53.2%); diabetes (27.2%); dyslipidemia (46.2%); smoking (39.3%); mean BMI (30.6 ± 4.7); median GFRe (63.2 ml/min/1.73m2); prior major cardiovascular event (21.4%). After treatment intensification (spironolactone: 51.4%, beta-blockers:26.6%, spironolactone plus beta-blocker:17.9%, spironolactone plus beta-blocker plus central antihypertensive agent: 4.1%), the proportion of controlled patients at 3 months was 64.7% as assessed by ABP measurement.Most of the patients with seemingly resistant hypertension can reach blood pressure target provided they undergo thorough work up and care by a multidisciplinary team.