Although hypertension results in the development of HF, once advanced HFrEF is manifest, lower BP is associated with a worse prognosis, and simi- larly, a higher BP is associated with a better prognosis. This is attributable to a loss of myocardial contractility in advanced HF, which suggests a poor prognosis. In these patients, the higher SBP may be a marker of the abil- ity of the ventricle to generate a SBP or better cardiac output. However, it should be noted that the BP ranges demonstrated to have an association with mortality in retrospective analyses were not defined or validated as targets in prospective, controlled trials and should not be accepted as a target for BP control in patients with HF. In the Digitalis Investigation Group trial database, mor- tality was significantly higher for patients in the lowest SBP group (<100 mmHg) than in the reference group of patients with an SBP of 130 to 139 mmHg (HR, 1.65; Similar results were reported by the Valsartan Heart Failure Trial (Val-HeFT), in which patients in the lowest quartile of SBP (SBP 110 mmHg) had more severe HF and a significantly increased mortality (HR, 1.21; 95% CI, 1.03 1.43; P=0.02) and hospitalization for HF (HR, the upper 3 quartiles of baseline SBP (mean SBP, 130 ; Figure 2). Similar findings are noted in patients with acute decompensated HF.87 90 In a meta-analysis of 10 studies of a total population of 8088 subjects, higher SBP resulted in better out- comes in patients with established HF.91 Studies included in this analysis had a maximum SBP of 158 mmHg. The decrease in mortality rates associated with a 10 mmHg higher SBP was 13.0% in the HF population. 