AbstractBackgroundArterial elastance to left ventricular elastance ratio assessed by echocardiography is widely used as a marker of ventricular‐arterial coupling.Materials and methodsWe investigated whether the ratio of carotid‐femoral pulse wave velocity, as a marker of arterial stiffness, to global longitudinal strain, as a marker of left ventricular performance, could be better associated with vascular and cardiac damage than the established arterial elastance/left ventricular elastance index. In 299 newly‐diagnosed untreated hypertensives we measured, carotid‐femoral pulse wave velocity, and carotid intima‐media thickness, coronary‐flow reserve, arterial elastance/left ventricular elastance, global longitudinal strain, and markers of left ventricular diastolic function (E/A and E’) by echocardiography.ResultsPulse wave velocity‐to‐global longitudinal strain ratio (PWV/GLS) was lower in hypertensives than controls (−0.61 ± 0.21 vs −0.45 ± 0.11 m/sec%, P < 0.001). Low PWV/GLS values were associated with carotid‐intima media thickness > 0.9 mm (P = 0.003), E/A ≤ 0.8 (P = 0.019) and E’ ≤ 9 cm/sec (P = 0.002) and coronary‐flow reserve < 2.5 (P = 0.017), after adjustment for age, sex and mean arterial pressure. Low PWV/GLS was also associated with increased left ventricular mass and left atrial volume in the univariate (P = 0.003 and 0.038) but not in the multivariate model. In hypertensives, there was no significant association of arterial elastance‐to‐left ventricular elastance index with carotid intima media thickness, coronary flow reserve, E/A, E’, or left atrial volume with the exception of an inverse association with left ventricular mass (P = 0.027).ConclusionsPulse wave velocity‐to‐global longitudinal strain ratio but not the echocardiography‐derived arterial elastance‐to left ventricular elastance index is related to impaired carotid‐intima media thickness, coronary‐flow reserve and diastolic function in hypertensives.