Electrical carotid baroreflex activation therapy is an emerging device-based treatment for patients with treatment-resistant hypertension. Its blood pressure lowering effect has been demonstrated in several animal and human studies. In addition, this treatment has showed its prolonged effect over the long-term. The main mechanism of the blood pressure reduction during this therapy is by inhibition of the sympathetic outflow. Yet the question arises whether the inhibition of central sympathetic activity is sufficient to be the sole mechanism behind the sustained reduction in blood pressure. In this lecture, we will present the latest data on the effect of baroreflex activation therapy on blood pressure, the mechanisms of action that account for the persistent blood pressure lowering, the most suitable candidates for this treatment and future developments on the field of baropacing.