Endovascular renal artery denervation, using radiofrequency energy or ultrasound or alcohol for ablation, has demonstrated good efficacy and safety to lower ambulatory blood pressure over a 3 month to 3-year period, proven by sham-controlled, multi-center, randomized controlled trials. While initial subjects were those with resistant hypertension, on multiple antihypertensive medication, subsequent trials have shown impressive results even in medication-naïve patients. At present, this device-based therapy is a promising option that may be applied alone or as a complementary therapy to antihypertensive medication. Individual patient preference should be considered as part of a shared patient-physician decision process, while the procedure establishes its longer-term durability and safety. As a sympathectomy procedure, it is found to be of value in other conditions too, such as cardiac arrhythmias, heart failure and obstructive sleep apnea.