For a study, it was determined that in patients with heart failure, lower systolic blood pressure (SBP) was linked to poor outcomes. This link in cardiac failure with maintained ejection fraction was less well understood (HFpEF). Researchers wanted to determine if there were any links between SBP levels and mortality and other outcomes in people with HFpEF. The Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry included 25,354 patients who were discharged alive; 8,873 (35.0%) had an ejection fraction of at least 50%, and of these, 3,915 (44.1%) had stable SBP levels (≤20 mm Hg admission to discharge variation). Between March 1, 2003, and December 31, 2004, data was collected from 259 hospitals in 48 states. From March 1, 2003, through December 31, 2008, data was evaluated. SBP values at discharge should be less than 120 mm Hg. SBP levels were less than 120 mm Hg in 1,076 of 3,915 patients (27.5%), of whom 901 (83.7%) were matched by propensity scores with 901 patients with SBP levels of 120 mm Hg or more who were balanced on 58 baseline variables. Through December 31, 2008, the researchers tracked 30-day, 1-year, and overall all-cause mortality, as well as heart failure readmission. The average (SD) age of the 1,802 matched patients was 79 (10) years, with 1,147 (63.7%) women and 134 (7.4%) African Americans. 30-day all-cause death occurred in 91 (10%) and 45 (5%), respectively, of matched patients with discharge SBP less than 120 mm mm Hg versus 120 mm Hg or above (hazard ratio [HR], 2.07; 95% Confidence interval, 1.45-2.95; P<.001). A lower systolic blood pressure of less than 120 mm Hg was also linked to an increased risk of death after one year (39% vs 31%; HR, 1.36; 95% CI, 1.16-1.59; P<.001) and throughout a median follow-up of 2.1 (total 6) years (HR, 1.17; 95% CI, 1.05-1.30; P=.005). A lower systolic blood pressure of less than 120 mm Hg was linked to a higher risk of heart failure readmission at 30 days (HR, 1.47; 95% CI, 1.08-2.01; P=.02), but not at 1 or 6 years. The hazard ratios for heart failure readmission or all-cause mortality associated with SBP less than 120 mm at 30 days, 1 year, and overall were 1.71 (95% confidence interval, 1.34-2.18; P<.001), 1.21 (95% CI, 1.07-1.38; P=.004), and 1.12 (95% CI, 1.01-1.24; P=.03), respectively. SBP less than 120 mm Hg is substantially related to poor outcomes in hospitalized individuals with HFpEF. Future research should look into the best SBP therapy targets for patients with HFpEF.