Hypertension is among the most significant global health issues to date and is closely related to the autonomic nervous system, as evidenced by short-term heart rate variability (HRV). Short-term HRV is a noninvasive marker of the autonomic regulation of cardiac activity, related to the balance between sympathetic and parasympathetic activity. This is a narrative review on the complex interaction between hypertension and short-term HRV, considering pathophysiological mechanisms, clinical implications, and potential applications in diagnosis and management. Evidence has shown that hypertension is associated with reduced HRV, which means autonomic dysfunction and increased cardiovascular risk. The mechanistic pathways include alterations in increased sympathetic activity, and reduced vagal tone. Decreased HRV has also emerged as a predictor of the development and progression of hypertension, suggesting that it may be a useful biomarker. However, standardization of HRV measurement and interpretation are some of the challenges that have been identified. This review integrates the current knowledge, highlights gaps in understanding, and proposes directions for future research that may help leverage HRV in the management and risk stratification of hypertension.