Recent research has noted a pathological link between the heart and kidney, known as cardio-renal syndrome. However, little is clear about the pathophysiological mechanism behind it. A relationship of altered central hemodynamics to microalbuminuria in hypertension has been demonstrated ( Hypertension 2011;58:839-846). The present study was conducted to investigate two hypotheses: 1) a link between albuminuria and plasma B-type natriuretic peptide (BNP); and 2) involvement of central hemodynamics in this link. In 392 patients with uncomplicated hypertension (age, 56±12 years), the radial pressure waveforms were recorded with applanation tonometry to estimate the central aortic pressure parameters. The pulse wave velocity (PWV) was measured in carotid-femoral (aortic) and carotid-radial (peripheral) regions. Albuminuria was defined as urinary albumin/creatinine ratio (UACR) ≥30 mg/g of creatinine. The log-transformed BNP (median, 14 pg/ml) was correlated ( P ≤0.006) with aortic systolic ( r =0.31) and pulse ( r =0.46) pressures, aortic forward ( r =0.41) and augmented ( r =0.26) pressures, mean arterial pressure ( r =0.14), and aortic ( r =0.39) but not peripheral ( r =–0.09) PWV. The correlation with the aortic pulse pressure tended to be closer than the brachial pulse pressure ( P =0.07). The BNP was correlated ( P <0.001) positively with UACR ( r =0.34), and negatively with estimated glomerular filtration rate (eGFR, r =–0.39). The presence of albuminuria was associated with an elevation of BNP (≥40 pg/ml) in a stepwise logistic model adjusted for age, body mass index, diabetes, eGFR, use of renin-angiotensin inhibitors and β-blockers (odds ratio: 2.74; P =0.007). Of note, however, additional adjustment for the aortic pulse pressure rendered this association statistically insignificant, and the aortic pulse pressure emerged as the strongest predictor of the BNP elevation (odds ratio: 1.41 per 10mmHg increase; P =0.003). In each patient subgroup with normo-, micro-, and macro-albuminuria, wider aortic pulse pressure was always associated with higher BNP level. In conclusion, albuminuria and elevated BNP are closely connected in hypertension. The central hemodynamics plays a pivotal role in mediating this cardio-renal connection.