In hypertensive patients the risk of developing cardiovascular events and complications depends not only on the magnitude of the blood pressure elevation, but also, and to a consistent extent, on the presence of associated cardiovascular risk factors, concomitant disease and target organ damage. Recent findings suggest that also sympathetic overdrive and alterations in blood pressure variability (which are detected in hypertension) may participate at the increased cardiovascular risk of the patients with high blood pressure. This review will discuss the evidence collected over the past few years on the relationships between sympathetic activation and blood pressure variability and their impact on cardiovascular risk profile.