Carotid baroreceptors play an important role in blood pressure regulation through modification of sympathetic nervous activity. Conditions associated with increased sympathetic activity, such as resistant hypertension and heart failure, represent potential targets for carotid baroreceptor activation. Recent technological advances made available a small device, like a pacemaker, that constantly activates carotid baroreceptors. Primary experimental and clinical data obtained from use of this device point toward significant blood pressure reduction in patients with resistant hypertension, as well as beneficial effects on cardiac structure and function. A large feasibility trial revealed promising results; however, the first randomized study in patients with resistant hypertension raised several concerns regarding the efficacy and safety of baroreceptor activation with the device. This review critically evaluates available data obtained with carotid baroreceptor activation, emphasizing data acquired during the past year, and discusses the advantages and disadvantages as well as the future prospects of this intervention.