In cirrhosis, arterial vasodilatation leads to central hypovolaemia and activation of the sympathetic nervous (SNS) and renin-angiotensin-aldosterone systems (RAAS). As the liver disease and circulatory dysfunction may affect baroreceptor reflex sensitivity (BRS), we assessed BRS in a large group of patients with cirrhosis and in controls all supine and some after 60° passive head-up and 30° head-down tilting in relation to central haemodynamics and activity of the SNS and RAAS. One-hundred and five patients (Child classes A/B/C: 21/55/29) and 25 (n=11+14) controls underwent a full haemodynamic investigation. BRS was assessed by cross-spectral analysis of variabilities between blood pressure and heart rate (HR) time series. The median BRS was significantly lower in the supine cirrhotic patients, 3.7 (0.3-30.7) msec/mmHg than in matched controls (n=11), 14.3 (6.1-23.6), p<0.001. A stepwise multiple-regression analysis revealed that serum sodium (p=0.044), HR (p=0.027), and central circulation time (CCT) (p=0.034) independently correlated with BRS. Head-down tilting had no effects on BRS, but after head-up tilting, BRS was similar in the patients (n=23) and controls (n=14). In conclusion, BRS is reduced in cirrhosis in the supine position and relates to various aspects of cardiovascular dysfunction, but no further reduction was observed in parallel with the amelioration of the hyperdynamic circulation after head-up tilting. The results indicate that liver dysfunction and compensatory mechanisms to vasodilatation may be involved in the low BRS, which may contribute to poor cardiovascular adaptation in cirrhosis.