Renal nerves are critical in regulation of blood pressure and renal function. The concept of renal denervation is based on solid pathophysiologic principles and both experimental and human data. Renal denervation has consistently shown to reduce blood pressure in patients with resistant hypertension and complex to manage blood pressure. This occurs both in the clinical trial environment and in observational studies. The procedure works effectively through the disruption of the pathophysiological sympathetic drive to and from the kidney to produce its antihypertensive effect. Renal denervation is now considered a valid option for BP lowering in European and American Hypertension Guidelines.