Resistant hypertension (RHTN) is defined by the new 2013 guidelines as failure to lower blood pressure (BP) values under 140 mmHg (for systolic BP) and 90 mmHg (for diastolic BP) despite proper lifestyle measures plus antihypertensive therapy including a diuretic and two other BP lowering agents at adequate doses. It has repeatedly been shown that patients with RHTNhave an especially high risk for cardiovascular and renal events and thus have become subjects of extensive research aimed at reducing BP values through the use of minimally invasive therapies such as renal denervation (RD) and carotid baroreceptor electrical stimulation. Sympathetic RD is an endovascular catheter-based procedure approved and in current use around Europe. Since 2007 over 4000 patients have been subject of this approach with apparently very good results on BP levels as shown by clinical trials (Simplicity 1, 2 and on-going Simplicity 3). The mechanism by which RD improves management of BP values is rather complex, involving factors like decreasing renal afferent and efferent sympathetic signaling to kidneys, increasing renal blood flow, lowering plasma renin activity, enhancing natriuresis. It is a somewhat simple procedure for trained medical personnel, as is involves vascular access in a similar way as renal angiography and angioplasty. As a result of the positive effects on BP values evidenced in clinical trials, sympathetic RD recently entered the European guidelines published in 2013 for management of HTN, with a class of recommendation IIb. The long-term safety of this procedure however remains to be proven in larger clinical trials currently on-going throughout Europe.