The treatment of severe hypertension by the surgical obliteration of the renal sympathetic nerves was proposed almost 80 years ago. This approach, although highly effective in reducing blood pressure was associated with a significant amount of side effects and it was rapidly replaced by better tolerated medical therapy. The rapid progress in catheter based technologies occurring within the last 20 years facilitated the development of the first radio frequency renal artery denervation catheter. At the present time, several small trials have demonstrated the safety and efficacy of this approach among patients with refractory hypertension. Besides its effect on reducing blood pressure, other pleiotropic effects (ie, improving glycemia in diabetic patients) have been proposed. In this review, we discuss the anatomical and physiological rationale for this therapy, provide an update on the latest clinical data available and describe additional emerging technologies in this field.