Background Control of blood pressure following acute type B aortic dissection usually requires the use of multiple antihypertensive medication. Although sympathetic nerve activity is central to blood pressure control, its role in the hypertensive response to acute aortic dissection has not been assessed. Methods A prospective pilot study was performed over an 18-month period. Patients presenting with acute type B aortic dissection, confirmed on computed tomographic angiography (CTA) were recruited. We measured blood pressure, heart rate, muscle sympathetic nerve activity (MSNA) and plasma catecholamine levels in patients following acute type B dissection and controls. Comparisons between groups were made one week (acute phase) and three months after dissection (recovery phase). Results Five patients and four controls were recruited in the study. MSNA tended to be higher in patients than controls during the acute phase of aortic dissection (62.0 compared to 45.5 bursts/min, p=0.41), and fell during the recovery period to 42 bursts/min (p=0.29). Plasma normetanephrines also tended to be increased during the acute phase (821 vs 417 ρmol/L, p=0.29). Conclusion Assuming recovery phase levels are similar to baseline, sympathetic nerve activity is increased during the first week after acute type B aortic dissection. Further studies are warranted to clarify the time course of this response and assess potential effects of treatment with sympatholytic treatment during recovery.