There is a paucity of data regarding the relation between the various noninvasive indexes of arterial stiffness and left ventricular diastolic function. In 188 subjects aged > or =65 years (mean 75 +/- 5; 71% men), the concordance and strength of the association between measures of arterial stiffness and left ventricular diastolic function were evaluated. Indexes of arterial stiffness (brachial and aortic pulse pressure [PP], carotid-femoral pulse-wave velocity [PWV], and augmentation pressure [AP]) were measured using applanation tonometry. Diastolic function was classified in terms of instantaneous diastolic function grade and quantitated as left atrial volume, a measure of chronic diastolic burden. Risk for new cardiovascular events was estimated using a validated clinical echocardiographic risk algorithm. Aortic and brachial PP, PWV, and AP were correlated positively with left atrial volume and diastolic function grade. After adjusting for age, gender, and clinical and echocardiographic covariates, 1-SD increases in aortic PP, brachial PP, PWV, and AP were associated with 6%, 6%, 4%, and 4% increases in indexed left atrial volume, respectively. Similarly, 1-SD increases in aortic PP, brachial PP, and AP were associated with 84%, 81%, and 83% increased risk for diastolic dysfunction, respectively (all p <0.04). PWV and aortic and brachial PP were superior to AP in discriminating subjects with the highest risk of having new cardiovascular events (5-year risk >50%; area under receiver-operating characteristic curve 0.67, 0.67, 0.70, and 0.56, respectively; p <0.05). In conclusion, increased arterial stiffness was associated with more severe left ventricular diastolic dysfunction, although the strength of the association varied according to the specific measure used. Aortic PP, brachial PP, and PWV appeared superior to AP in risk discrimination in this elderly cohort.