Purpose: The aim of our study is to explore the clinical determinants of the intrarenal haemodynamics (IRH) and carotid haemodynamics in a group of patients with heart failure and preserved ejection fraction (HFpEF). Methods: The population of our study were 66 patients (34 females and 28 males, mean age 58.65 ± 16.50 years) with HFpEF. All subjects underwent careful clinical history and physical examination. A complete echocardiographic study, ambulatory blood pressure monitoring and color Doppler ultrasound of external carotid artery, renal and intrarenal arteries were performed to all the subjects. Intrarenal Doppler measurements were repeated in three parts of both kidneys (superior, median, and lower) until three reproducible waveforms were obtained. The following IRH parameters were obtained: renal resistive index (RRI), renal pulsatile index (RPI), acceleration time (AT), as well as carotid resistive index (CRI) and carotid pulsatile index (CPI). Results: The mean RRI was 0.6672 ± 0.0452, mean RPI 1.2533 ± 0.178, mean AT 66.68 ± 2.324 ms, mean CRI 0.8912 ± 0.0941, CPI 1.5612 ± 0.345, mean daytime ambulatory systolic blood pressure (SBP) was 153.73 ± 12.82 mmHg, mean nighttime SBP was 138.32 ± 16.35 mmHg, mean 24 hours SBP was 146.12 ± 13.96 mmHg, mean daytime ambulatory diastolic blood pressure (DBP) was 92.07 ± 18.93 mmHg, mean nighttime DBP 81.79 ± 8.34 mmHg mean 24 hours DBP 86.59 ± 6.78 mmHg. The mean pulse pressure (PP) was 59.10 ± 22.90 mmHg. The mean 24 hours heart rate (HR) was 75.14 ± 26.86 beats/minute. RRI as well as the RPI were negatively related to ambulatory 24 hours DBP (r = -0.239, p < 0.01), (r = -0.139, p < 0.01), mean nighttime DBP (r = -0.299, p<0.01), (r = -0.129, p<0.01), HR (r = -0.326, p<0.01), (-0.123, P<0.01). There was a positive association of only IRR with ambulatory 24 hours SBP (r = 0.359, p < 0.01), mean daytime SBP (r = 0.260, p<0.05) ambulatory PP (r = 0.266, p < 0.01), age (r = 0.253, p < 0.01), left ventricular mass (LVM) (r = 0.459, p < 0.001) and relative wall thickness (RWT) (r = 0.293 p<0.01), statistically significant even after adjustment for various confounding factors. CRI as well as the CPI were negatively related to ambulatory 24 hours DBP (r = -0.139, p < 0.01), (r = -0.147, p < 0.01), mean nighttime DBP (r = -0.216, p<0.01), (r = -0.107, p<0.01), HR (r = -0.254, p<0.01), (-0.104, P<0.01). In multiple regression analysis, mean 24 hours SBP, daytime SBP, PP (p < 0.01) and LVM (p <0.05) were revealed as main determinants of RRI, RPI, CRI, CPI in patients with HFpEF, meanwhile we didn’t find an important correlation of AT and any clinical or haemodynamic parameter in this particular group of patients. Conclusions: In addition to local renal vascular properties, the carotid haemodynamic factors have a significant influence on the intrarenal arterial patterns in patients with HFpEF.