Abstract: Objective To investigate the predictive value of blood pressure and its changes during hospitalization on all-cause mortality in patients with chronic heart failure. Methods A total of 3 928 patients with confirmed diagnosis of chronic heart failure were collected from three hospitals in Shanxi Province from March 2014 to February 2019. The admission and discharge blood pressures were measured and the change rates of discharge blood pressure were calculated. All-cause mortality was used as the study endpoint. The deadline for follow-up was March 1, 2022. Univariate and multivariate Cox proportional risk regression models were used to analyze the risk factors for death, and restrictive cubic spline plots were used to analyze the effect of blood pressure on all-cause mortality in different age groups. Results The mean admission blood pressure was（131±20）/（78±12） mmHg and the mean discharge blood pressure was（122±15）/（73±9） mmHg. During a median follow-up of 5.17 years, all-cause mortality occurred in 504 patients, with an all-cause mortality rate of 12.8%. Compared with the low blood pressure group admission systolic blood pressure（SBP） ＜90 mmHg and/or admission diastolic blood pressure（DBP） ＜60 mmHg, patients in the normal（admission SBP 90-＜140 and DBP 60-＜90 mmHg） and high blood pressure groups（admission SBP≥140 mmHg and/or DBP≥90 mmHg） had a lower all-cause motality rate（12.1%, 13.1% vs 23.3%, χ~2=11.230; P=0.004）. Univariate Cox regression analysis showed that discharge SBP and DBP, admission DBP, discharge SBP change rate were predictors of all-cause mortality in patients with chronic heart failure（all P＜0.05）. Multivariate Cox regression analysis showed that admission DBP（HR=0.989; 95%CI 0.981-0.997） and discharge SBP change rate（HR=0.987; 95%CI 0.981-0.994） were independent predictors of all-cause mortality in patients with chronic heart failure. The adjusted restricted cubic spline graph showed that patients with admission DBP＜75 mmHg and discharge SBP decreased by more than 14.8% compared to admission could increase the risk of all-cause mortality. Layered analysis showed that the discharge SBP change rate（HR=0.987; 95%CI 0.979-0.994） and admission DBP（HR=0.989; 95%CI 0.981-0.998） were independent predictors for all-cause mortality in elderly patients（≥65 years old）, while admission DBP（HR=0.982; 95%CI 0.966-0.998） was an independent predictor for all-cause mortality in middle-aged and young patients（＜65 years old）. Conclusion Admission DBP＜75 mmHg and discharge SBP decreased by more than 14.8% compared to admission are risk factors of all-cause mortality in patients with chronic heart failure.