Hypertension is highly prevalent and one of the most frequent chronic diseases worldwide.1 Prognoses for the next decades suggest that up to 50% of the adult population will be diagnosed as hypertensives using the standard guideline definitions of hypertension.1 Approximately 5–20% of all patients with high blood pressure are resistant to drug treatment,2 defined as blood pressure uncontrolled (>140/90 mm Hg; >130–139/80–85 mm Hg in patients with diabetes mellitus; >130/80 mm Hg in chronic kidney disease), despite the use of at least three antihypertensive agents of different classes, including a diuretic, at maximum or highest tolerated doses.3 Attention should be paid to differentiate between true resistance and pseudo-resistance, which is probably related to poor medication adherence, situational evoked blood pressure elevation (white coat hypertension), or suboptimal drug combination.4 In approximately 20% of all patients suffering from resistant hypertension, a secondary, potentially reversible cause can be found, which should be excluded systematically in all such individuals.2 ,4 Current non-invasive therapeutic strategies are mainly based on lifestyle interventions and pharmacological treatment.3 There is a mass of evidence indicating the profound effect of the sympathetic nervous system on all phenotypes of hypertension, which is consequently a relevant target for new therapeutic strategies.5 ,6 This article evaluates the treatment of resistant hypertension by catheter based renal sympathetic denervation.