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Abstract   Aims  Recent guidelines recommend a systolic blood pressure (SBP) target below 130 mmHg in heart failure patients with preserved ejection fraction (HFpEF), whatever their age. We investigated whether this intensive SBP control was associated with better survival in very old adults hospitalized for acute HFpEF.    Methods and results  We conducted an observational study in an acute geriatric unit: all consecutive patients discharged from hospital for acute heart failure from 1 March 2019 to 29 February 2020 with a diagnosis of HFpEF were included. Re‐hospitalization and all‐cause mortality at 1 year were compared according to the mean SBP at discharge (patients with a mean SBP &lt; 130 mmHg vs. those with SBP ≥ 130 mmHg). We included 81 patients with a mean age of 89 years. Among them, 47 (58%) were re‐hospitalized and 37 (46%) died at 1 year. All‐cause mortality (hazard ratio [HR] [95% confidence interval]: 1.50 [0.75–2.98],  P  = 0.2) and re‐hospitalization rate (HR: 1.04 [0.58–1.86],  P  = 0.90) at 1 year did not significantly differ between patients with SBP ≥ 130 mmHg and those with SBP &lt; 130 mmHg at discharge. However, a prescription for antihypertensive drugs at discharge was associated with a better long‐term prognosis (all‐cause mortality: HR: 0.42 [0.20–0.88],  P  = 0.02; re‐hospitalization rate: HR: 0.56 [0.28–1.10],  P  = 0.09).    Conclusions  Although SBP &lt; 130 mmHg at discharge was not associated with a better prognosis among very old patients hospitalized for acute HFpEF, the prescription of antihypertensive drugs was associated with mortality and re‐hospitalization rates that were reduced by half. Future prospective studies are needed to assess target blood pressure in very elderly patients with HFpEF.

Prognostic impact of systolic blood pressure in acute heart failure with preserved ejection fraction in older patients