Objective: The purpose of the present study is to investigate whether subjects with stiff arteries have an increased risk of heart failure.

Methods: The present study is performed within the framework of the Rotterdam study. Blood pressure, aortic pulse wave velocity and carotid distensibility measurements were obtained. Subjects with heart failure at baseline were excluded. We included 4121 subjects with blood pressure measurements, 3290 subjects with information on aortic pulse wave velocity and 2936 subjects with carotid distensibility measurements. Cox proportional hazard models, adjusted for cardiovascular risk factors, were performed to investigate the risk of heart failure associated with blood pressure and arterial stiffness.

Results: The mean age of the subjects was 72 years, 41,5 % was men. After a mean follow- up of 4.1 years 254 subjects had a heart failure. Hazard ratios and corresponding 95% CI of heart failure for systolic, diastolic, pulse and mean arterial pressure were 1.21 (1.08–1.36), 0.94 (0.83–1.06), 1.31 (1.17–1.46) and 1.08 (0.96–1.22), respectively.

After including both systolic and pulse pressure in one model, only the pulse pressure predicted incident heart failure; estimates for systolic and pulse pressure were 0.90(0.69–1.18) and 1.40(1.07–1.85), respectively. Aortic pulse wave velocity increased the risk of heart failure in subjects up to 70 years (HR 1.72;1.23–2.40), whereas the carotid distensibility did not.

Conclusions: The pulsatile components of blood pressure and aortic stiffness are associated with the risk heart failure in the general population.