Background:  Atherosclerosis develops gradually with a subclinical change in arterial elasticity. Pulse pressure index (PPI) (i.e. pulse pressure/systolic blood pressure) could be a predictive parameter of decreased arterial compliance. Objective: This study aimed to evaluate whether brachial PPI (BPPI) is an independent predictor for increased Carotid intima-media thickness (CIMT), and additionally, whether BPPI is superior to brachial pulse pressure (BPP) in the prediction of subclinical atherosclerosis. Methods: In this cross-sectional study, 115 patients, aged 40-60 years, who attended Minia University Hospital Medical units, were recruited. Subjects who had a history of coronary heart disease or stroke or were prescribed to drugs that could affect blood pressure on the day of the study were excluded. CIMT at a cut-off value of > 0.9 mm was used as a reference measure.  Results: The mean values of BPPI and BPP were 0.37±0.06 and 49.17±12.59, respectively. Subjects with BPPI ≥ 0.36 (median value) had higher CIMT (0.81±0.15 versus 0.72±0.14) compared to those with BPPI < 0.36. After multivariate analysis was completed, BPPI had significant correlation with CIMT (unstandardized coefficient β = 0.938, p < 0.001). The areas under the receiver operating curve for BPPI and BPP in the prediction of CIMT > 0.9 mm were 0.702 (p <0.001) and 0.598 (p =0.001), respectively. Conclusion: BPPI is a valuable predictive tool for subclinical atherosclerosis with higher predictive accuracy compared to BPP.