Objective To study the effects of ablation site in catheter-based renal sympathetic denervation (RDN) on antihypertensive results in patients with resistant hypertension. Methods A total of 16 patients with resistant hypertension were evenly randomized into two groups: proximal or distal ablation group. RDN was performed after examination. The ablation parameters, including impedance starting value, minimum impedance, actual wattage, and the actual temperature, were recorded intraoperatively. Renal angiography was done again immediately after RDN. Standardized BP measurements were obtained in all patients for 3 months after operation. Results All the 16 patients underwent RDN successfully. The average initial impedance of the 16 patients was (180.0±12.3) Ω, average minimum impedance was (157.8±12.8) Ω, and average impedance drop rate was (12.4±2.6)%. The actual ablation temperature was 40-50℃, with the actural ablation wattage being 5-18 W. The renal angiography showed two cases of renal artery spasm in the distal ablation group and none in the proximal group, with no significant difference found in the incidence between the two groups (P=0.08). There was no significant difference in BP between the two groups 3 months after RDN. Conclusion Proximal ablation, particularly at the opening of renal artery, may not influence the antihypertensive effect of RDN, and to some extent it can reduce the incidence of renal artery stricture.