Peripheral brachial blood pressure measurements by sphygmomanometry remains the standard for measuring and managing blood pressure. Elevated brachial blood pressure is a major risk for cardiovascular disease, and reduction of bracial blood pressure decreases target organ damage and cardiovascular events. However, many patients still succumb to heart disease, stroke, kidney failure, and death even when the brachial blood pressures appear adequately controlled. Central aortic pressure may be more relevant to the pathogenesis of cardiovascular disease, which is not always accurately represented by brachial blood pressure. Noninvasive applanation tonometry can now assess central aortic pressure easily and reliably. Emerging data suggest that central arotic pressure and related parameters are often better and more robust predictors of cardiovascular outcome than peripheral brachial blood pressures.