This study investigated the prevalence, severity, and significance of pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) in a community-based population. Among 244 HFpEF patients, 83% had PH, with a median PASP of 48 mmHg. PH was more prevalent and severe in HFpEF compared to hypertensive patients without HF. PASP was significantly higher in HFpEF than in HTN, even after adjusting for pulmonary capillary wedge pressure (PCWP). PASP was a strong predictor of mortality in HFpEF, with a hazard ratio of 1.3 per 10 mmHg increase. PH was also a potent adverse prognostic factor in HFpEF, independent of age. The study suggests that both pulmonary venous and pulmonary arterial hypertension contribute to PH in HFpEF. While pulmonary venous hypertension contributes to PH, it does not fully account for its severity, indicating a role for pulmonary arterial hypertension. The study highlights the importance of PH as a marker of pulmonary congestion and a potential therapeutic target in HFpEF. The findings suggest that therapies aimed at pulmonary arterial hypertension may be beneficial in HFpEF. The study also notes the limitations of echo-derived PASP measurements and the need for further research to validate these findings in other populations. Overall, PH is highly prevalent and often severe in HFpEF, and its presence is associated with increased mortality. The study underscores the need for further investigation into the pathophysiology and treatment of PH in HFpEF.This study investigated the prevalence, severity, and significance of pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) in a community-based population. Among 244 HFpEF patients, 83% had PH, with a median PASP of 48 mmHg. PH was more prevalent and severe in HFpEF compared to hypertensive patients without HF. PASP was significantly higher in HFpEF than in HTN, even after adjusting for pulmonary capillary wedge pressure (PCWP). PASP was a strong predictor of mortality in HFpEF, with a hazard ratio of 1.3 per 10 mmHg increase. PH was also a potent adverse prognostic factor in HFpEF, independent of age. The study suggests that both pulmonary venous and pulmonary arterial hypertension contribute to PH in HFpEF. While pulmonary venous hypertension contributes to PH, it does not fully account for its severity, indicating a role for pulmonary arterial hypertension. The study highlights the importance of PH as a marker of pulmonary congestion and a potential therapeutic target in HFpEF. The findings suggest that therapies aimed at pulmonary arterial hypertension may be beneficial in HFpEF. The study also notes the limitations of echo-derived PASP measurements and the need for further research to validate these findings in other populations. Overall, PH is highly prevalent and often severe in HFpEF, and its presence is associated with increased mortality. The study underscores the need for further investigation into the pathophysiology and treatment of PH in HFpEF.