We examined heart rate and blood pressure variability (HRV and BPV) during graded tilt (5 min in each position: supine, -10 degrees, 10 degrees, 30 degrees, 60 degrees, -10 degrees, supine) in autonomic failure patients and age-matched controls. Heart rate was not different between patients and controls and increased with tilt (P < 0.001). Total HRV was reduced in patients (P < 0.03). Patients had reduced low-frequency (0-0.15 Hz) HRV and BPV (P < 0.005). With tilt, low-frequency BPV increased in controls, whereas high-frequency (> 0.15 Hz) BPV increased in patients. The slope of the fractal component (beta) for HRV and BPV was not different between patients and controls. HRV-beta increased (1.5-1.9, P < 0.01) with tilt, but BPV-beta (approximately 1.8) was unaffected. Values of beta close to 1 indicate high signal regulatory complexity, and values of beta close to 2 indicate low complexity. HRV and BPV provide clear evidence of impaired sympathetic and parasympathetic autonomic nervous system response to tilt with autonomic failure. The similarity in signal complexity with reduced fractal and harmonic spectral power, in patients compared with controls, suggests unchanged cardiovascular neural input and integration with reduced output in autonomic failure.