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Central blood pressure (BP) is suggested to be more closely correlated to target organ damage and cardiovascular events than brachial BP. Outcome-based thresholds for the diagnosis of central hypertension has been recently proposed. However, little is known about central hypertension. In an untreated patient cohort, we therefore investigated the prevalence of central hypertension and its association with target organ damage.Consecutive untreated patients referred for ambulatory BP monitoring to our Hypertension Clinic were recruited. Office brachial and central BP were measured using the Omron 7051 (Omron, Japan) and SphygmoCor (AtCor, Australia) devices, respectively. Patients were cross-classified according to the presence of brachial and central hypertension defined as a brachial and central systolic BP of at least 140 mmHg and 130 mmHg, respectively. Measures of target organ damage, including left ventricular mass index by echocardiography (GE, E9), carotid-femoral pulse wave velocity (cfPWV) and urinary albumin-to-creatinine ratio (ACR), were determined.The 1928 participants (mean age, 51 years; women, 52%) included 1036 (54%) patients with brachial and central consistent normotension, 662 (34%) brachial and central combined hypertension, 74 (4%) isolated central hypertension, and 156 (8%) isolated brachial hypertension. Compared to patients with isolated brachial hypertension, patients with brachial and central combined hypertension had significant greater urinary ACR (0.96 vs. 0.68 mg/mmol, P < 0.001) and more patients with microalbuminuria (5% vs 0.7%, P = 0.017), faster cfPWV (8.50 vs. 8.17 m/s, P = 0.003), but similar left ventricular mass index (85.7 vs. 86.6 g/m2, P = 0.60) after multivariate adjustment. Patients with isolated central hypertension also had faster cfPWV (7.83 vs. 7.51 m/s, P = 0.03) than those with consistent normotension.Central hypertension was prevalent (about 38%) in this untreated patient cohort, 90% combined with brachial hypertension. Brachial and central combined hypertension was associated with worse target organ measures and might be a subtype we shall pay attention to.