Aortic stiffness is an independent predictor of cardiovascular mortality in a variety of patient groups including hypertensives and other unselected patients. Despite a sound pathophysiologic basis, termed the ventricular-vascular coupling mechanism, the relationship between aortic stiffness and heart failure has been less well studied. This review summarizes some important trials of aortic stiffness in cardiovascular disease risk prediction and progression to heart failure. Emerging targets for therapeutics and areas requiring more research are also discussed.