58 patients with severe arterial hypertension (AH) refractory to antihypertensive drug therapy including beta-blockers, calcium antagonists, antiadrenergic drugs and diuretics with addition of captopril and/or minoxidil were studied. In all the patients 3-6 sessions of plasmapheresis (PA) with plasma exchange up to 30 ml/kg body weight per 1 session were performed. After the course of plasmapheresis BP depression on the average by 24% as well as restoration of sensitivity to antihypertensive drugs and elimination of signs of malignant AH in certain cases were observed. PA was not enough effective in patients with AH combined with signs of chronic renal failure. Persistent BP depression as a result of the treatment is probably caused by positive hormonal changes, improved renal function, increased sensitivity of tissue receptors of target organs to antihypertensive drugs as well as improved peripheral blood circulation.