Autonomic cardiovascular control is impaired in hypertension, involving both the parasympathetic and sympathetic component of the reflex modulation. The autonomic dysfunction depends on a variety of reflex and non-reflex mechanisms and participates in the complex cardiometabolic alterations, known as “end-organ damage”, detectable in the clinical course of hypertensive disease. This paper will review the main features of the vagal and adrenergic dysfunction characterizing essential hypertension, the mechanisms potentially involved in this neural abnormality as well as the effects of therapeutic intervention.