Abstract: Resistant hypertension and the target-organ damage caused by it are among the important causes of disease-related mortality. Immune imbalance is involved in the onset and progression of resistant hypertension. Contributing immunological factors include T lymphocyte-mediated cellular immune responses, B lymphocyte activation and the resulting humoral immune responses, as well as activation of innate immune cells. In addition, autoantibodies against the angiotensin Ⅱ type 1 receptor, β-adrenergic receptors and α-adrenergic receptors have been detected in the plasma of patients with hypertensive disorders of pregnancy, malignant hypertension, renal hypertension and other forms of hypertension, contributing to the suboptimal efficacy of conventional antihypertensive drugs. Immune intervention with immunomodulatory drugs and receptor-targeted peptide agents represents a new therapeutic direction for resistant hypertension. However, most existing studies have focused on individual immune cell populations or specific autoantibodies, and a systematic synthesis extending from immune imbalance to autoimmune disease remains lacking. This review examines the evidence for immune imbalance, the regulatory roles of immune cell subsets, the pathogenic mechanisms of autoantibodies, the current status of clinical translation and future directions, with the aim of systematically elucidating the immune mechanisms underlying the onset and progression of resistant hypertension and providing a reference for its immune-targeted therapy.