OBJECTIVES: Evaluate a new service for refractory hypertension (RH) management in Belarus, an Eastern European country with a significant rise in cardiovascular morbidity, mortality, and the highest hospital discharge rate for hypertensive emergencies in Europe. METHODS: One hundred cases of ambulatory patients with RH consulted during 2003 at Vitebsk Regional Center for RH (RH-Center created in October, 2002) were retrospectively analyzed, including adherence to and effectiveness of a recommended treatment regimen during a 6-month period. The clinical practice at the RH-Center differs from the routine one in several technologies, including screening for reasons of refractory states performed by a qualified hypertension specialist; blood pressure (BP) and arterial compliance monitoring; patient’s quality of life, social stress and support testing to control the adherence level. RESULTS: In the patient sample studied, the recommended treatment regimen was preserved in 67 cases, and in 43 (64%) the treatment effectiveness was judged as sufficient (systolic BP change by 10% or more). In the last 33, the recommended regimen was substantially changed by general practitioner (ten patients) or by patient himself (23 cases), lack of grounded reasons for that being registered in 5 and 20 cases, correspondingly. Rate of patients’ applying for emergency service and hospitalization both in adherent and non-adherent portions of the sample was significantly lower compared to a 6-month period preceding the first RH-Center visit. CONCLUSIONS: The first experience of hypertension specialist service implementation in Belarus was positive. The service combining hypertension specialist care with hemodynamic, metabolic and psychosocial profiling approaches the problem of RH in a systematic fashion and rational basis. Hence, it can improve cost-effectiveness of the most expensive and difficult for management group of hypertensive patients. Our experience should spread to other Belarusian regions and CIS countries, where proportion of resistant hypertensives is high.