A recent study indicated that upstroke time per cardiac cycle (UTCC) in lower extremities is equivalent to ankle-brachial index (ABI) in diagnosing peripheral arterial disease and in predicting cardiovascular mortality. In this study, we aimed to compare ABI and UTCC in relation to target organ damage. A cohort of 1841 elderly participants from the Northern Shanghai Study was studied. ABI and UTCC were measured using VP-1000 device. Target organ damage including left ventricular hypertrophy and diastolic dysfunction, carotid intima-media thickness and plaque, carotid-femoral pulse wave velocity (CF-PWV), and renal damage, were evaluated by standardized methods. In correlation analysis, ABI and UTCC both significantly correlated with CF-PWV, carotid plaque, and estimated glomerular filtration rate, but not with cardiac damage. Compared with ABI, UTCC showed stronger correlation with CF-PWV. When ABI and UTCC separately put into fully adjusted multivariate logistic regression models, both ABI (OR: 2.27; 95% CI: 1.63–3.17) and UTCC (OR: 1.63; 95% CI: 1.18–2.24) significantly associated with carotid plaque, but only UTCC significantly associated with increased CF-PWV (OR: 1.66; 95% CI: 1.15–2.42) and renal damage (OR: 1.63; 95% CI: 1.07–2.47). When ABI and UTCC both put into multivariate stepwise logistic regression models together with covariates, consistent results were observed. In ROC curve analysis, after adjusted for cofounding factors, UTCC showed slightly greater area under curve than ABI in detecting increased CF-PWV (area under curve: 0.79 vs. 0.78; P = .008); however, no difference was observed between UTCC and ABI in discriminating renal damage and carotid plaque. In conclusion, compared with ABI, UTCC showed significantly stronger association with vascular and renal damage in this elderly Chinese cohort.