OBJECTIVE: The sustained elevation of blood pressure (BP) and especially of central pulse pressure (cPP) leads to heart and brain damage. This pilot study was aimed to precise the relationships between peripheral and central BP levels, and the remodeling of heart and brain as objectively quantified by cardiac MRI and brain F-fluorodeoxyglucose (FDG)-PET imaging in the elderly. METHODS: Twenty-eight apparently healthy elderly individuals (66-85 years old, 14 women) were prospectively recruited and allocated into two half groups, one with and one without hypertension, and all were referred for the quantitative determinations of peripheral and central BP using applanation tonometry, indexed left ventricular mass (per m of body surface area) using cardiac MRI, and brain metabolism with a voxel-based analysis of FDG-PET images adjusted for age and sex. RESULTS: Indexed left ventricular mass, reflecting cardiac remodeling, was correlated with the overall pressure variables involving both peripheral and central levels of systolic and pulse pressure (all P ≤ 0.001). By contrast, brain metabolism was significantly correlated with only cPP (P < 0.02). A cPP of at least 50  mmHg was associated with both a lower metabolism in frontal areas (P = 0.005) and a higher indexed left ventricular mass (P = 0.03). CONCLUSION: This pilot study suggests that, when quantified by MRI and PET imaging, left ventricular mass and brain metabolism of elderly individuals are related to the cPP and to the 50  mmHg threshold, corresponding to what has previously been documented for the risk of cardiovascular event.