A direct relationship between brachial pulse pressure (PP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) has been demonstrated. NT-proBNP is a marker of cardiac overload and sensitive marker of heart failure. Brachial PP is an indirect marker of arterial stiffness and central pressure, whether arterial markers, mild elevation of BNP, or both directly contribute to excessive rate of events is unknown (question mark). Whether other mechanisms such as endothelial dysfunction or small artery disease contributes is unknown.