Hypertension is a significant complication after orthotopic heart transplant (OHT); as a sign of diminished parasympathetic activity also reduced heart rate variability (HRV) is depressed. Aim of the study was to investigate correlations between Blood Pressure (BP) and HRV during 24 hours BP/ECG simultaneous recording (Cardio(x)plore device - Meditech). Cardiovascular risk as a degree of HRV depression was considered.Twenty OHT patients (P) (7 F, 13 M - 18,7 ± 5,2 yrs) were evaluated. Mean systolic and diastolic BP (SBP, DBP) (24 hours, daytime and nighttime) and total spectral power of HRV were examined; patients were also considered for cardiovascular risk (low, medium or high, respectively SDNNA>100, SDNNA between 50 and 100, SDNNA<50). Six P were treated for hypertension and 3/20 were affected by hypertension before transplantation. Hypertensive P showed higher cyclosporine blood levels while no significant correlations were found between BP values and HRV. When considered for SDNNA, 7/20 (35%) were at high risk, 11/20 at medium risk (55%) and only 5 patients (10%) were at low risk. ABPM showed 4 P (20%) with mean BP values higher than 95th during the day, 7 P (35%) had reduced nocturnal fall in SBP and 2 P had a nocturnal rise in BP. Abnormalities of BP and evidence of a depressed HRV were frequent in our population. The well-tolerated simultaneous 24-hours BP/ECG recording was helpful to obtain BP and HRV profiles during the same daily-activities. Antihypertensive treatment was effective in terms of class of drug choice, time and dose of administration.