This study was conducted to clarify whether the second peak of the systolic blood pressure (SBP2) has significant information about cardiovascular (CV) risk state, independent of the brachial BP. SBP2 was measured by radial pressure wave analysis in 7847 Japanese subjects (50+/-10 years old), and the Framingham risk score (FRS) and general cardiovascular disease risk score were calculated (FRSgen). The results of multivariate analysis revealed that the SBP2 showed a significant correlation with the FRS (beta=0.04, t-value=3.92, P<0.01) and FRSgen (beta=0.05, t-value=6.55, P<0.01), independent of the brachial SBP. The non-standardization coefficient of SBP2 was smaller than that of brachial SBP. The logistic regression analysis showed that SBP2 (2 mm Hg per increase) had a significant odds ratio to identify not only subjects with a high risk for coronary heart disease (CHD) and general CV disease (CVDgen), but also subjects with a low risk for CHD and CVDgen, independent of the brachial SBP. However, when the analysis was limited to subjects of >or=49 years of age, SBP2 could not identify either high or low CV risk subjects. Thus, in middle-aged Japanese subjects, SBP2 may provide little, yet significant, information reflecting both high and low CV risk states, independent of the brachial BP. SBP2 seems to be more applicable for CV risk stratification in younger subjects than in older subjects.