Arterial stiffness is significantly correlated with cardiovascular risk in patients with hypertension. Although arterial stiffness increases with age and other vascular risk factors, the effect of heart rhythm on arterial stiffness is uncertain. The aim of this study was to determine whether the presence of atrial fibrillation is associated with arterial stiffness, as determined by heart to femoral pulse wave velocity, in patients with hypertension. Heart to femoral pulse wave velocity was measured, and comprehensive transthoracic echocardiography was performed in 68 subjects (35 subjects with sinus rhythm, 33 subjects with atrial fibrillation). Potential determinants of heart to femoral pulse wave velocity were identified by univariate and multivariate analyses. Individuals with atrial fibrillation had higher heart to femoral pulse wave velocity than those with sinus rhythm (1028 +/- 222 vs 923 +/- 110 cm/s, P = .03). Age, the presence of atrial fibrillation, systolic blood pressure, and pulse pressure were found to be significantly correlated with heart to femoral pulse wave velocity. After adjusting for possible con-founders, multivariate analysis identified systolic blood pressure (P = .003) and the presence of atrial fibrillation (P = .007) as independent determinants of heart to femoral pulse wave velocity. The presence of atrial fibrillation was significantly correlated with a higher pulse wave velocity, independently of age or blood pressure in patients with hypertension.