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Objective: Evidence suggests the superiority of office aortic pressure over brachial on the evaluation of vascular damage and prognosis of cardiovascular disease (CVD); 24-hour ambulatory blood pressure monitoring (ABPM) is regarded the optimal method for assessing blood pressure (BP) profile. The non-invasive 24-hour aortic ABPM is feasible and superior to 24-hour brachial regarding the association with left ventricular hypertrophy and diastolic dysfunction. The aim of our study was to examine the association of 24-hour aortic and brachial ABPM with common carotid artery (CCA) hypertrophy. Methods: Consecutive subjects referred for CVD risk assessment underwent 24-hour aortic and brachial ABPM using a validated oscillometric brachial cuff-based devise (Mobil-O-Graph). CCA hypertrophy was assessed by high-resolution ultrasound (assessment of intima media thickness - IMT). Results: 497 subjects (aged 54 ± 13 years, 57% men, 80% hypertensives) were examined. Using Hotelling’s-Williams test it was shown that 24-hour aortic BP was significantly better correlated with IMT as compared with brachial BP (r: 0,254 vs. r: 0,202 for right IMT, r: 0,244 vs. r: 0,207 for left IMT, p < 0,05). Multivariate analysis (adjusted for possible confounders) revealed superiority of 24-hour aortic BP regarding the association with IMT as well as carotid hypertrophy. Last, in ROC analysis, aortic BP had a higher discriminatory ability compared to brachial for the detection of carotid hypertrophy (AUC: 0,707 vs. 0,656 for right carotid artery hypertrophy, AUC: 0,636 vs. 0,602 for left carotid artery hypertrophy, p < 0,05). Conclusions: Non-invasively assessed 24-hour aortic pressure is more strongly associated with CCA IMT and provides a higher discriminatory ability for the detection of CCA hypertrophy.