Vascular disease is a known risk factor for pressure ulcer development, but the underlying mechanisms of this association are less established. The authors evaluated the relationship between endothelial function (EF) and history of pressure ulcers in a nested case-control study of community-dwelling elderly, 60 years and older. Endothelial function was measured using peripheral arterial tonometry, and persons with a history of pressure ulcers in the past 5 years (n = 7) were matched 2:1 by age and gender to controls with no history of pressure ulcers (n = 14). Overall endothelial function was significantly worse in persons with pressure ulcers compared to controls (1.32 versus 1.76, respectively; P = 0.04), and the prevalence of endothelial dysfunction was higher among cases than controls as well (100% versus 43%, respectively; P = 0.04). Other vascular risk factors were similar in both groups. Endothelial dysfunction appears to be associated with pressure ulcer history and may reflect an underlying vascular etiology through which ulcer risk is mediated.