© The Author(s) 2022.This study sought to analyze the relationship between pulse pressure (PP) index (PPI) (PP/systolic blood pressure; a less variable and objective form of PP) and coronary artery disease (CAD) progression. A registry of 193 patients was evaluated to show CAD progression by comparing current vs previous (6 months to 3 years prior) angiograms. One day after the second angiogram, we conducted ambulatory blood pressure measurements on the patients. Of the 193 patients, 65 (34%) had CAD progression. The PP and PPI were significantly higher in the progression than in the non-progression group (55 ± 12 vs. 51 ± 10 mmHg, P =.02 and.47 ±.06 vs.42 ±.05, P =.004, respectively). Also, the PP and PPI were independently predictive of CAD progression (OR = 1.03, P =.03 and OR = 6.47, P =.01, respectively). Moreover, the correlation of PPI with low-density lipoprotein cholesterol and glycosylated hemoglobin was greater than their correlation with PP. In addition, PPI predicted CAD progression better than PP (area under the curve [AUC] =.649 vs.574, P =.03). Elevated PP and PPI may be associated with the progression of CAD. PPI seems more successful in predicting CAD progression than PP.