This study aimed to define the prevalence, severity, and significance of pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) in the general community. The study included 244 HFpEF patients and 719 hypertensive control subjects without HF. Pulmonary artery systolic pressure (PASP) was derived from tricuspid regurgitation velocity, and PH was defined as PASP > 35 mmHg. The results showed that PH was present in 83% of HFpEF patients, with a median PASP of 48 mmHg. PASP increased with pulmonary capillary wedge pressure (PCWP) but remained higher in HFpEF compared to hypertensive controls after adjusting for PCWP. PASP distinguished HFpEF from hypertensive controls with excellent diagnostic accuracy and strongly predicted mortality in HFpEF. The findings suggest that PH is highly prevalent and severe in HFpEF, and its presence may be a significant prognostic factor. The study also highlights the potential role of pulmonary arterial hypertension in the development of PH in HFpEF, suggesting that therapies targeting pulmonary arterial hypertension may be beneficial in this patient population.This study aimed to define the prevalence, severity, and significance of pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) in the general community. The study included 244 HFpEF patients and 719 hypertensive control subjects without HF. Pulmonary artery systolic pressure (PASP) was derived from tricuspid regurgitation velocity, and PH was defined as PASP > 35 mmHg. The results showed that PH was present in 83% of HFpEF patients, with a median PASP of 48 mmHg. PASP increased with pulmonary capillary wedge pressure (PCWP) but remained higher in HFpEF compared to hypertensive controls after adjusting for PCWP. PASP distinguished HFpEF from hypertensive controls with excellent diagnostic accuracy and strongly predicted mortality in HFpEF. The findings suggest that PH is highly prevalent and severe in HFpEF, and its presence may be a significant prognostic factor. The study also highlights the potential role of pulmonary arterial hypertension in the development of PH in HFpEF, suggesting that therapies targeting pulmonary arterial hypertension may be beneficial in this patient population.