Diastolic heart failure (or heart failure with preserved ejection fraction – HFPEF, which is the contemporary denomination of the condition) and increased arterial stiffness/wave reflections are closely linked from an epidemiological perspective. Both are usually found in elderly patients, with long-standing hypertension, with a predominance of female gender. Consecutive cross-sectional studies indeed established the presence of increased arterial stiffness/wave reflections in individuals with diastolic dysfunction and in HFPEF-patients. More mechanistic trials showed that key characteristics of diastolic dysfunction (invasively or non-invasively derived left ventricular filling pressures, natriuretic peptides, tissue-Doppler measurements of relaxation) are closely related to estimates of arterial stiffness (Pulse Wave Velocity) and wave reflections (Pressure Augmentation, Augmentation Index, backward wave amplitude). These findings are supported by previous experimental studies, proving that an increase in late-systolic load can impair diastolic function. As HFPEF often manifests as exertional dyspnea, measures of arterial stiffness may be relatively normal at rest, but rise inadequately during exercise, and exactly this phenomenon has been shown in HFPEF patients. With respect to treatment of HFPEF, we are currently facing a serious lack of evidence-based recommendations. Studies using angiotensin-receptor antagonists have largely failed, but the presence of the condition (HFPEF) in many of the patients included in the largest trial performed so far has been questioned. Interestingly, the extent of improvement of diastolic function has been directly linked to the extent of blood pressure fall with treatment. Recently, a study investigating the effects of spironolactone, a drug with proven beneficial effects on pulsatile hemodynamics, has shown promising results in HFPEF. Furthermore, interventional treatment (renal sympathetic denervation) of patients with resistant hypertension has resulted in improvements in diastolic function as well as arterial stiffness and wave reflections.