Neurogenic supine hypertension, a manifestation of autonomic failure, predominantly occurs in patients with neurogenic orthostatic hypotension. Both conditions result from structural damage to the autonomic nervous system, leading to impaired vascular constriction and blood pressure regulation. Blood pressure management in patients with neurogenic orthostatic hypotension combined with supine hypertension poses significant clinical challenges. While this comorbidity is more common in middle-aged and elderly populations, it is exceptionally rare in young patients, resulting in limited diagnostic and therapeutic references. This article reports the case of a young female patient presenting with recurrent dizziness and blood pressure fluctuations, aiming to provide insights for the diagnosis and management of similar cases.