The function of the heart is necessarily linked to the function of the arterial system. The heart expels the blood, and the arteries serve as a conduit and a cushion between the heart and the microcirculation. This review aims to answer the questionsdfrom a clinical cardiologist’s point of viewdif and how impaired arterial function, particularly increased arterial stiffness (increased pulse wave velocityPWV) and increased arterial wave reflections (increased pulse pressure-PP, increased augmentation index-AIx, increased pressure augmentation-AP) may impair cardiac function and ultimately lead to heart failure. The first consideration is that increased arterial stiffness/wave reflections will increase pulsatile external work of the heart. As opposed to steady external work, which is useful for tissue perfusion, pulsatile external work is lost in the large arteries (and comprises normally, i.e. with compliant arteries, only 10 percent). Its increase may lead to “overload cardiomyopathy”. Epidemiological data confirmed that increased brachial PP, a crude surrogate for arterial stiffness, is associated with an increased risk for developing heart failure. Importantly, these data were