Neurocognition, Lifestyle Modification, and Treatment Resistant Hypertension

Inclusion Criteria: * Documented resistant hypertension (RH). In the absence of a specific RH diagnosis, individuals being treated for two or more weeks with 3 antihypertensive medications of different classes, including a diuretic if tolerated, with clinic SBP ≥ 130 mm Hg or DBP ≥ 80 mm Hg, will be eligible. Individuals being treated with 4 or more antihypertensive medications, including a diuretic if tolerated, with SBP ≥ 120 or DBP ≥ 80 mm Hg will also be eligible. * Adherent to prescribed medications * Overweight (BMI ≥ 25 kg/m2) * Sedentary * Willing to be randomized to one of the 2 treatment groups and able to fully participate in intervention * Informed consent Exclusion Criteria: * Secondary HTN, non-adherence to anti-HTN medications * Severe CKD (eGFR \<40 ml/min/1.73m2) * Severe ischemic heart disease (CCS Class 3 or 4 angina or evidence of ischemia at \<85% heart rate reserve on treadmill testing) * Severe heart failure (NYHA association Class 3 or 4), high grade arrhythmias, severe valvular heart disease * Severe asthma or chronic obstructive lung disease * Diabetes requiring insulin * Musculoskeletal or neurologic problems that would preclude participation in aerobic exercise training * Major psychiatric disorder, a history of drug abuse, alcohol consumption \>14 drinks/week * Life-limiting comorbid medical condition such as cancer * Prior gastric bypass surgery * Currently pregnant * Cognitively impaired