Aerobic granules (AG) have good settling ability and are relatively insensitive to the variation of organic loading rate. When sizes of granules become bigger, substrate and oxygen become limited in the granule core, leading to cell lysis and disintegration of granules. The higher the dissolved oxygen, the deeper the oxygen penetration inside AG. AG operated under elevated pressure might be a possible way to maintain long-term stability of granules. In this study, formation and characteristics of AG in the reactor operated under elevated high pressure (HP) and ambient pressure (AP) are investigated. Results show that both systems removed an average 95% of total organic carbon. Sludge volume index at 5 and 30 min settling times under HP are 35% smaller those under AP, indicating that HP granules have a better settling ability and a denser structure than AP granules. The granule size in the HP system is very uniform, while size distribution in the AP system is broader, indicating that the AP system contains flocculent sludge. Extracellular polymeric substances and polysaccharides (PS) are almost the same for HP and AP; however, exopolymeric protein (PN) is very different. PS/PN ratio for HP sludge is four times that of AP. The result is consistent with sludge settleability, which is improved with increasing PS/PN ratio.