Black patients who have heart failure (HF) may have a larger proportion of HF with preserved ejection fraction (PEF) than white patients because of the greater prevalence and severity of hypertension and left ventricular hypertrophy in blacks. However, studies have not systematically evaluated differences by race in patients who have HF-PEF compared with those who have systolic HF (SHF). Therefore, we examined baseline characteristics and long-term outcomes in patients who had HF-PEF compared with those who had SHF, with an emphasis on variation by race, in a biracial cohort of patients treated within the Veterans Health Administration health care system. In a cohort of 448 patients (192 blacks and 256 whites) hospitalized with HF, 27% had HF-PEF. The proportion of HF-PEF was similar in black (25%) and white (29%) patients (p = 0.4). Among patients who had SHF, black patients were younger, had lower prevalences of atrial fibrillation and diabetes, and had less co-morbidities than white patients, whereas there were no significant differences in these variables by race in patients who had HF-PEF. However, among patients who had SHF or HF-PEF, blacks had a lower prevalence of coronary disease, higher systolic and diastolic blood pressures, and higher serum levels of creatinine than white patients. In addition, mortality and readmission rates for HF did not differ by race among patients who had HF-PEF. Overall, patients who had HF-PEF had a high morbidity rate (30% patients were readmitted for HF in ≤6 months) and a high mortality rate (44% at 3 years), despite the use of angiotensin-converting enzyme inhibitors by 66% of patients at discharge. This underscores the importance of evaluating other agents for the treatment of patients who have HF-PEF.