Key Points Renal sympathetic denervation may serve as a treatment alternative in patients with resistant systemic arterial hypertension. Ablation at the proximal and distal renal artery branches with an irrigated catheter did not lead to better blood pressure reduction than proximal ablation alone. Pitfalls in study design prevent from drawing definite conclusions in the present randomized study. Careful design of randomized trials is essential to delineate the role of RD with saline‐irrigation catheters.