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Aims: To determine the relationship between admission systolic blood pressure (SBP) and mortality in older patients hospitalized for heart failure (HF) and among various subgroups., Methods and Results: We evaluated the independent association between initial SBP and 30-day and 1-year mortality, and potential interactions by age, gender, race, previous hypertension, and left ventricular dysfunction using multivariable logistic regression in the National Heart Failure Project, a database of Medicare patients >65 years old recruited from 1998 through 2001. Among 56 942 patients, mean admission SBP was 147.0 + or - 92.3 mmHg, 15% presenting with SBP >180 mmHg. Systolic blood pressure showed an inverse relationship with 30-day and 1-year mortality rates in all subgroups analysed. Using admission SBP of 120-149 mmHg as the reference, the adjusted odds ratios (95% confidence intervals) for 1-year mortality were 2.18 (1.77-2.69) for SBP <90 mmHg, 1.57 (1.47-1.69) for SBP 90-119 mmHg, 0.71 (0.67-0.76) for SBP 150-179 mmHg, 0.63 (0.57-0.68) for SBP 180-209 mmHg, and 0.51 (0.44-0.59) for SBP > or = 210 mmHg., Conclusion: Higher SBP on admission is associated with significant lower 30-day and 1-year mortality in patients hospitalized for HF. The relationship is strong, graded, independent of other clinical factors and consistent among subgroups.