Cardiovascular (CVS) diseases remain a leading cause for morbidity and mortality worldwide. The aim of our study was to assess cardiovascular reactivity in healthy young adults with family history related increased CVS risk. 48 individuals aged 20-24 years were studied: 38 with family history for CVS diseases, obesity and/or diabetes type 2 – F+ group; 10 were their age matched controls without family history – F-. All subjects gave informed consent for their study participation. The orthostatic test, which consisted of three 5-minute periods – baseline supine (BAS), active standing (OT) and supine recovery (REC), was applied as a sympathetic challenge. Continuous electrocardiogram, non-invasive blood pressure and brachial-ankle pulse wave velocity (ba-PWV) were recorded using BiopacMP100 and Finapress device. Data were analyzed by means of the Acknowledge and MIS2000 software. Blood pressure variability (BPV) was assessed with fast Fourier analysis (FFT). The spectral α-index of spontaneous baroreflex sensitivity (BRS) was calculated (Pitzalis et al. 1998). Ba-PWV was measured for arterial stiffness evaluation (Sugawara et al. 2005). Results are presented in Table 1 as means ± SEM. Statistical significance was evidenced with the t-test. CVS response to OT in F+ was more pronounced. Systolic arterial pressure (SAP) was significantly higher during the 3 studied periods; F+ responded to OT with a larger increase in SAP as compared to F-. BPV was considerably higher in F+ although statistical significance could not be shown due to the well known interindividual variance in this parameter. BRS decreased during OT (more markedly in F+). During REC BRS indices were significantly lower in F+ as compared to F-. Pulse pressure (PP) and ba-PWV data were higher in F+. Our data suggest the existence of subtle changes in the autonomic cardiovascular function with a sympathetic predominance in F+, which is in conjunction with our previous studies (Belova et al., 2007). An early and clinically non-manifested autonomic dysregulation might explain the higher CVS reactivity and the less sensitive baroreflex leading to greater BPV in F+. We might speculate that the increased sympathetic outflow to vascular smooth muscle cells causes functional increase of arterial stiffness and underlies the greater pulse pressure as well. We suggest that OT might be used as a screening tool for individuals at higher CVS risk and for primary prevention of CVS diseases.