This study validated high hydrostatic pressure processing (HPP) for achieving greater than 5-log reductions of Escherichia coli O157:H7 in carambola juice and determined shelf life of processed juice stored at 4 °C. Carambola juice processed at 600 MPa for 150 s was identified capable of achieving greater than 5.15-log reductions of E. coli O157:H7, and the quality was compared with that of high temperature short time (HTST)-pasteurized juice at 110 °C for 8.6 s. Aerobic, psychrotrophic, E. coli/coliform, and yeasts and moulds in the juice were reduced by HPP or HTST to levels below the minimum detection limit (< 1.0 log CFU/mL), and showed no outgrowth after refrigerated storage of 40 days. There were no significant differences in pH and titratable acidity between the untreated, HPP, and HTST juices. However, HTST treatment significantly changed the color of juice, while no significant difference was observed between the control and HPP samples. HPP and HTST treatments reduced the total soluble solids in the juice, but maintained higher sucrose, glucose, fructose, and total sugar contents than untreated juice. The total phenolic and ascorbic acid contents were higher in juice treated with HPP than untreated and HTST juice, but there was no significant difference in the flavonoid content. Aroma score analysis showed that HPP had no effect on aroma, maintaining the highest score during cold storage. The results of this study suggest that appropriate HPP conditions can achieve the same microbial safety as HTST, while maintaining the quality and extending the shelf life of carambola juice.