BACKGROUND: Hypertension is ubiquitous in patients with heart failure and preserved ejection fraction (HFpEF) and contributes to arterial and ventricular stiffening. Exertional dyspnea may result from diastolic dysfunction with exercise; however, the association of central blood pressure (BP) to left ventricular filling pressure during exercise has not been assessed in this population and was the aim of this study. METHODS: Fifteen patients with HFpEF and 15 age-matched and sex-matched controls were studied at rest, during submaximal and immediately after maximal exercise. Simultaneous echocardiography and radial tonometry was performed to measure E/e' and central BP, defined by central augmented pressure (C_AP) and augmentation index (AIx). RESULTS: Patients with HFpEF had higher E/e' (P = 0.020) and peripheral and central BP (P < 0.001) at rest, yet similar C_AP and AIx to controls (P > 0.05). There was a large increase in E/e' with exercise in patients (P = 0.012) but no change in C_AP or AIx. Importantly, the change in E/e' from rest to submaximal exercise was significantly and independently associated with ΔC_AP (r = 0.559; P = 0.030) and ΔAIx (r = 0.654; P = 0.008) in patients with HFpEF. In contrast with the controls, E/e', C_AP and AIx decreased with exercise and there were no associations between exercise E/e' and central or peripheral BP (P > 0.05 for all). CONCLUSION: Indices of central BP are associated with the left ventricular diastolic response to exercise in patients with HFpEF. Arterial function and central hemodynamics may be important targets for treating symptoms associated with raised left ventricular filling pressure with exertion.