Introduction: The objectives were to evaluate the incidence, clinical features and ambulatory blood pressure monitoring (ABPM) data of resistant hypertension (RHT) in primary care units, compared with controlled hypertension (CHT). Methods: A number of 4681 hypertensive patients from 12 family medicine offices from Timiș County were evaluated between 2010 and 2014. RHT was considered present when office BP values were > 140/90 mm Hg in patients treated with three drugs at maximal doses, one being a diuretic. Results: Offi ce BP values were > 140/90 mm Hg in 673 patients (14.8%), considered to present RHT. In these patients, ABPM documented normal BP values in 34.77%, classified with white coat RHT. An abnormal ABPM was present in 439 (65.23%) patients. Of these, after complete evaluation, finally only 366 patients remained diagnosed with true RHT (7.81%), as in 73 patients pseudo-RHT (PRHT) was documented. PRHT was related to medication in 35.62%, to excessive sodium intake in 26.03%, to secondary hypertension in 26.03% and to different other causes in 17.81%. Compared with controlled HT, true RHT patients had an older age, a worse CV risk profile, including higher proportions of smokers (19.1% versus 14.9%), of diabetics (31.9% versus 26.6%), CVD (22.9% versus 17.1%) and TOD (28.9% versus 17.12%). Conclusions: After exclusion of WCRHT and PRHT, in the study remained only 7.81% patients with true RHT. True RHT patients, in comparison with CHT, were more frequently smokers, diabetics, non-dippers, had a longer duration of HT and a greater incidence of TOD and CVD/CRD. ABPM is needed for the correct diagnosis and management of RHT. The most important cause of PRHT in primary care was non-adherence to the prescribed medication.