OBJECTIVES: The study aimed to estimate the healthcare resources used and costs among hypertensive patients with wide pulse pressure (wWPP) and without (woWPP) in Japan. METHODS: A retrospective chart review was conducted in 15 physicians’ offices distributed all over Japan. Two historic cohorts of patients were included with hypertension for ›3 years, ›20 years old, and two consecutive readings showing wWPP (pulse pressure ≥ 60 mmHg) or woWPP 3 to 5 years before inclusion. Patients were followed-up for three years. Variables retrieved were: sociodemographic data and comorbidities, variables related with hypertension, including target organ damage, hypertension management and the healthcare resources used for the last 12 months of follow-up. The study was approved by an IRB. Direct healthcare costs were estimated based on unit cost on annual basis from payer perspective. A regression model was performed for cost data. Statistical significance was set at p<0.05. RESULTS: Overall 276 patients participated; 150 wWPP vs 126 woWPP, 42.0% vs 63.5% males (p=0.0004), mean (SD) age 69.8 (9.9) vs 58.8 (9.9) years (p<0.0001). Mean (SD) healthcare resources cost of wWPP was ¥88,829.01 (USD 39,061.60), being 59.5% related to anti-hypertensive pharmacological treatment and 39.7% to outpatient visits. Mean (SD) cost of woWPP was ¥75,092.16 (31,899.12). Higher costs for wWPP patients were due to higher cost of pharmacological treatment (p=0.02) and higher costs of outpatient visits (p=0.002). In regression model, diagnosis of type-2 diabetes mellitus and target organ damage (cerebral hemorrhage/infarction, left ventricular hypertrophy, proteinuria) were related to a mean increase of total cost of ¥11,271 (p=0.0114) and ¥22,589 (p=0.0010), respectively. CONCLUSIONS: Patients wWPP were more frequently females and older than woWPP, and healthcare resources used were greater, mainly due to higher expenses on treatments and outpatient visits. Type-2 diabetes mellitus and target organ damage were associated to the cost increase.