Drug-resistant hypertension is present in about one in eight patients with high BP. It can be a frustrating and expensive condition to pursue from an office-based perspective. In this review, utilizing the American Heart Association scientific statement on drug-resistant hypertension as a guide, a case of drug-resistant hypertension is presented and walked through exactly as encountered by the author. Woven into the discussion is a combination of insights from the literature on this topic, blended with the experience of the author. This is not intended as an exhaustive review of each step in the evaluation and management process but, rather, as an overview incorporating a few carefully chosen references and, hopefully, a logical and useful approach to a common clinical challenge.