Percutaneous device-based intervention has received increasing attention over the past 10 years. Carotid baroreflex activation therapy holds promise as a device-based intervention to supplement, but not replace, drug therapy for patients with drug-resistant hypertension. In this Review, Victor provides an overview of the current body of evidence for the utility of this intervention in patients with drug-resistant hypertension, and discusses the promise and possible pitfalls of this technology, highlighting potential solutions.