Eleven moderately obese women, aged 46–62 years, with a body mass index of 29–34 and with borderline hypertension (repeated diastolic blood pressure >90 mmHg) fasted for 48 hours. Before the fast and after 48 hours of fasting, plasma noradrenaline, urinary noradrenaline, urine potassium, urine sodium and weight were measured. In six of the patients muscle nerve sympathetic activity was recorded from the peroneal nerve by tungsten micro‐electrodes for 15 min each time. The efferent muscle sympathetic activity (MSA) was expressed as the number of bursts/min. The recordings were done before the fast and after 48 hours of fasting. We found significant decreases in body weight from 88.4±2.5 kg to 86.4±2.5 kg. Systolic blood pressure (BP) was reduced from 158±3 mmHg to 146±5 mmHg (p<0.001) and diastolic BP from 96±3 mmHg to 89±3 mmHg (p<0.01) during the fast. MSA was significantly increased from 42.0±5.5 bursts/min to 44.5±5.8 (n=6), while plasma and urine noradrenaline concentrations (n = 11) showed a non‐significant tendency to increase. We conclude that the hypotensive response during the first days of extensive caloric reduction is not due to a decreased sympathetic activity. If anything, there may be weak increase of efferent sympathetic nerve activity and venous plasma levels of circulating noradrenaline. The mechanisms behind the acute hypotensive response to negative caloric balance are thus still unclear, but obviously different from long‐term adaptation of the blood pressure.