&NA;Our clinical experience in the management of five paraplegic or quadriplegic patients with subjective complaints and objective findings of autonomic hyper‐reflexia is presented. These five patients had epidural neurostimulation systems implanted percutaneously to regulate intractable spasticity. During a follow‐up period varying from 2 months to almost 2 years, four of the five patients experienced no episodes of autonomic dysfunction with the use of a low frequency, low voltage, square wave pulse output. From their responses and from recent neurophysiological evidence, the potential benefit of percutaneous epidural neurostimulation in the modulation of autonomic hyper‐reflexia without antihypertensive medication is suggested. Further follow‐up of these patients and additional clinical research should be performed to confirm our initial clinical impressions.