Aim To investigate the relationship between pulse pressure index (PPI) and carotid intima media thickness (IMT). Methods A total of 334 elderly patients were divided into 4 subgroups according to the level of pulse pressure (≤60 mmHg, 61～80 mmHg, 81～100 mmHg, >100 mmHg) and PPI (≤0.400, 0.401～0.500, 0.501～0.600, >0.600) respectively. Parameters of blood pressure, clinical features and carotid IMT were analyzed. Results The carotid IMT, systolic blood pressure, and age all increased when pulse pressure and PPI increased. However, diastolic blood pressure decreased with PPI increasing, but not when pulse pressure increased. The carotid IMT correlated best with PPI in Spearman's correlation analysis. The multiple factor stepwise regression analysis showed that only the regression of carotid IMT with PPI and age were of great significance, and the standard regression coefficiency of PPI was higher than age. Conclusion The PPI is better than pulse pressure in evaluating sclerosis of vessels in elderly patients.