The incidence and prevalence of both hypertension (HTN) and heart failure (HF) increase progressively with age. As a result, hypertensive HF (HHF) is highly prevalent among older adults and is one of the most common phenotypes of HF in the very old. In this article, the authors provide an overview of the epidemiology, pathophysiology, clinical features, diagnosis, management, prognosis, and prevention of HHF in the elderly population. Reducing the prevalence of HTN and ameliorating the progression from HTN to HF hold the greatest promise for limiting the impact of HHF on the health and well-being of older adults.