Arterial hypertension is a major cardiovascular risk factor with a high prevalence in western industrial countries and the proportion of patients with blood pressure at target values remains low. Patients with therapy-resistant hypertension, defined as failure to achieve target blood pressure despite a triple antihypertensive drug regimen including a diuretic, are at very high risk which supports the need for greater efforts towards improving hypertension outcomes in this population. Secondary causes of hypertension are often found in patients with resistant hypertension. Activation of the sympathetic nervous system has been identified as a main contributor to the development and progression of high blood pressure. Catheter-based renal denervation offers a new interventional treatment option resulting in a significant long-term reduction in blood pressure (> 36 months) and increased blood pressure control (up to 40% of the treated population). The basis for successful treatment is an appropriate patient selection, including life-style modification, exclusion of pseudoresistance, termination of substances increasing blood pressure and an optimized drug treatment. Further clinical studies are warranted and ongoing to determine the role of renal denervation in antihypertensive treatment.