Pulmonary hypertension (PH) is a common finding in patients with heart failure (HF) with a subset developing combined post- and pre-capillary PH (CpcPH). There is limited data on the characteristics and outcome of patients with CpcPH. We examined the clinical characteristics and echocardiographic properties of subjects with PH and CpcPH and its impact on clinical outcome. HF patients from a large echocardiography database with comprehensive clinical and outcome data were evaluated for PH severity and outcomes including mortality and cardiovascular hospitalizations. CpcPH was identified by estimating left ventricle mean filling pressures using the mitral E/e' ratio with a calculated transpulmonary gradient >15mmHg. The study included 2,793 patients with HF. 59% had elevated pulmonary pressures and 20% had CpcPH. Older age, chronic renal failure, severe tricuspid regurgitation, severe mitral regurgitation, higher right atrial pressure, and higher E/e' ratio were all associated with PH. Lower E/e' ratio, severe tricuspid regurgitation, higher peak right ventricular-right atrial gradient, and reduced right ventricular function were all indicative of CpcPH. At a median of 3,225 days follow-up, mortality was significantly higher in patients with PH compared to patients without PH and highest in atients with CpcPH. Cox regression analysis after adjustment for age, sex and other significant clinical variables demonstrated that PH was associated with increased mortality, with CpcPH exhibiting the highest risk (HR 1.53 CI 1.30-1.81, P<0.001). Death and cardiovascular hospitalizations were also significantly increased with PH severity. PH and CpcPH are highly prevalent in HF and are predictors of a worse prognosis