Background. Multiple Sclerosis (MS) is associated with autonomic nervous system damaged. Reported cardiovascular autonomic dysfunction (CAD) prevalence in MS varies between studies. As CAD lowers quality of life and may contribute to sudden death in MS, early CAD detection may assist in treatment and in risk identification. Methods. A comprehensive suite of cardiovascular autonomic tests was applied to 53 MS patients and results associated with clinical markers of MS severity. CAD was identified through analysis of continuous electrocardiogram and non-invasive finger blood pressure recording during 5-minutes supine rest, short-term deep breathing, Valsalva manoeuvre, orthostatic challenge and isometric exercise. There was greater prevalence of sympathetic (58%) than parasympathetic (34%) impairment. Total brain and spine lesions was correlated with dampened sympathetic response in Valsalva manoeuvre and orthostatic challenge (R2=0.22, p=0.010). Age corrected score for sympathetic control showed deterioration with longer disease duration (p=0.047) and treatment delay>10 years (p=0.007). Conclusion. Results indicate a high prevalence of CAD in MS that can be evaluated using non-invasive measures during cardiovascular challenges. Sympathetic markers may assist in diagnosing disease progression and are exacerbated with delay in treatment.