Heart failure and preserved ejection fraction (HFpEF) in patients is often complicated by abdominal obesity and arteriosclerosis. The aim of this study was to determine the relationship between adipose tissue distribution and arterial stiffness in patients with HFpEF.This was a cross-sectional descriptive study involving 93 patients with HFpEF. Several anthropometric measurements were measured, including height, weight, waist circumference, body fat mass, percent body fat, body fat rate, and visceral fat area (VFA). We calculated body mass index. Arterial stiffness was assessed by measurement of brachial-ankle pulse wave velocity (baPWV). The association between VFA and baPWV was investigated by linear regression analysis.In univariate analysis, VFA showed strong relations with bilateral baPWV in Spearman correlation analysis (P = 0.003 and P = 0.002, respectively). After adjusting for VFA, age, systolic blood pressure, diastolic blood pressure, and heart rate, VFA and age were significantly and positively associated with bilateral baPWV (P = 0.024 and P = 0.032, respectively). After adjusting for VFA, age, left ventricular posterior wall, and interventricular septal thickness, VFA and age were still significantly correlated with bilateral baPWV (P = 0.028 and P = 0.008, respectively).In patients with HFpEF, adipose tissue distribution was correlated with arterial stiffness. VFA was independently associated with baPWV.