Nearly half of all patients who have heart failure have preserved ejection fraction (HFpEF). Patients who have HFpEF tend to be older, female, and hypertensive, and characteristically display increased ventricular and arterial stiffening. In this article, we discuss the pathophysiology of abnormal ventriculoarterial stiffening and how it affects ventricular function, cardiovascular hemodynamics, reserve capacity, and symptoms. We conclude by exploring how novel treatment strategies targeting abnormal ventricular–arterial interaction might prove useful in the treatment of patients who have HFpEF.