This study examined the interactive effects of imagined rejection and narcissism on cardiovascular reactivity (CVR). Participants completed measures of overt narcissism (Narcissistic Personality Inventory, NPI; Raskin & Hall, 1979), overt–covert narcissism (Margolis & Thomas, 1980), and trait self-esteem. They then imagined 2 scenarios culminating in either interpersonal acceptance or rejection. Systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were assessed before, during, and after the imagery. Overt–covert narcissism was positively associated with task increases in SBP and DBP and recovery elevation of HR following rejection, but not acceptance. Similar effects on SBP were found for the Entitlement/Exploitativeness dimension of the NPI. Lower self-esteem predicted greater task increases in SBP, DBP, and HR across conditions. Implications for health are discussed.