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Background The exact form of the association between systolic blood pressure {SBP) and heart failure (HF) risk in the elderly remains incompletely defined, especially in individuals not receiving antihypertensive drugs. Objective To examine the association between SBP and HF risk in the elderly. Design Competing-risks proportional hazards modelling of incident HF risk, using 10-year follow-up data from two NIH-sponsored cohort studies: the Cardiovascular Health Study (inception: 1989-90 and 1992-3) and the Health ABC Study (inception: 1997-8). Setting Community-based cohorts. Participants 4408 participants {age, 72.8 (4.9) years; 53.1% women, 81.7% white; 18.3% black) without prevalent HF and not receiving antihypertensive drugs at baseline. Main outcome measures Incident HF, defined as first adjudicated hospitalisation for HF. Results Over 10 years, 493 (11.2%) participants developed HF. Prehypertension (120 -- 139 mm Hg), stage 1 (140-159 mm Hg), and stage 2 (≥160mm Hg) hypertension were associated with escalating HF risk; HRs versus optimal SBP (<120mm Hg) in competing-risks models controlling for clinical characteristics were 1.63 {95% CI 1.23 to 2.16; p=0.001), 2.21 (95% CI 1.65 to 2.96; p<0.001) and 2.60 (95% CI 1.85 to 3.64; p<0.001), respectively. Overall 255/493 (51.7%) HF events occurred in participants with SBP < 140 mm Hg at baseline. Increasing SBP was associated with higher HF risk in women than in men; no race -- SBP interaction was seen. In analyses with continuous SBP, HF risk had a continuous positive association with SBP to levels as low as 113 mm Hg in men and 112 mm Hg in women. Conclusions There is a continuous positive association between SBP and HF risk in the elderly for levels of SBP as low as <115 mm Hg; over half of incident HF events occur in individuals with SBP < 140 mm Hg. [ABSTRACT FROM AUTHOR]