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Hypertension is a known risk factor for the development of heart failure (HF); however, few data are available on the magnitude of short- and long-term progression from hypertension to HF. The present study aims to determine the short- and long-term incidence of HF, and identify factors associated with onset of HF in elderly hypertensive patients.The incidence of HF was measured in 6083 hypertensive patients, in the Second Australian National Blood Pressure Study (ANBP2), followed for a median of 10.8 years (4.1 years during the trial and 6.7 years during post-trial follow-up). A total of 373 cases of HF were identified over 59 581 person-years of follow-up (PY). The overall cumulative incidence of HF was 6.26 per 1000 PY; 5.33 per 1000 PY during the ANBP2 clinical trial and 7.04 per 1000 PY during the post-trial follow-up. HF was 63% higher among men [incidence rate ratios (IRR) 1.63, P < 0.01]. Older age, male sex, obesity, and history of cardiovascular disease independently predicted HF during both the short- and long-term follow-up. In addition, diabetes and smoking were associated with onset of HF in the short-term follow-up, and higher systolic blood pressure in the long-term follow-up. Median survival following diagnosis with HF was 3.94 years, and women (6.06 years) had a survival advantage over men (3.32 years).Heart failure is a frequent long-term outcome in treated elderly hypertensive patients. Development of HF was predicted by patient characteristics and co-morbidities, with the effect of some predictors varying over the short- and long-term follow-up.