Pulse pressure, an indicator of conduit vessel stiffness, has recently emerged as an important predictor of adverse cardiovascular events. The normally compliant conduit vessels provide an essential buffering role that minimizes potentially harmful pressure swings associated with intermittent pumping by the heart. A number of common conditions and acknowledged cardiac risk factors stiffen the conduit vessels, resulting in a vicious cycle of progressive vessel stiffening, increasing pulsatile load, pressure-related end-organ damage and clinical events. An emerging awareness of the central role of conduit vessel stiffness in cardiovascular pathophysiology has important implications for the classification and treatment of hypertension and other disorders that affect conduit vessel function and pulsatile hemodynamics.