Background: beta-Blockers have an uncertain effect in heart failure with a preserved ejection fraction of 50% or higher (heart failure with preserved ejection fraction [HFpEF]). Methods and results: We included patients with HFpEF from the Swedish Heart Failure Registry (SwedeHF) enrolled from 2011 through 2018. In a 2:1 propensity-score matched analysis (beta-blocker use vs nonuse), we assessed the primary outcome first HF hospitalization, the coprimary outcome cardiovascular (CV) death, and the secondary outcomes of all-cause hospitalization and all-cause death. We performed intention-to-treat and a per-protocol consistency analyses. There were a total of 14,434 patients (median age 79 years, IQR 71-85 years, 51% women); 80% were treated with a beta-blocker at baseline. Treated patients were younger and had higher rates of atrial fibrillation and coronary artery disease, and higher N-terminal pro-B-type natriuretic peptide levels. In the 4412:2206 patient matched cohort, at 5 years, 42% (95% CI 40%-44%) vs 44% (95% CI 41%-47%) had a HF admission and 38% (IQR 36%-40%) vs 40% (IQR 36%-42%) died from CV causes. In the intention-to-treat analysis, beta-blocker use was not associated with HF admissions (hazard ratio 0.95 [95% CI 0.87-1.05, P = .31]) or CV death (hazard ratio 0.94 [95% CI 0.85-1.03, P = .19]). In the subgroup analyses, men seemed to have a more favorable association between beta-blockers and outcomes than did women. There were no associations between beta-blocker use and secondary outcomes. Conclusions: In patients with HFpEF, beta-blocker use is common but not associated with changes in HF hospitalization or cardiovascular mortality. In the absence of a strong rational and randomized control trials the case for beta-blockers in HFpEF remains inconclusive. Bullet points: The effect of beta-blockers with heart failure with preserved ejection fraction of 50% or greater is uncertain. In a propensity score-matched heart failure with preserved ejection fraction analysis in the SwedeHF registry, beta-blockers were not associated with a change in risk for heart failure admissions or cardiovascular deaths. Lay summary: The optimal treatment for heart failure with a preserved pump function remains unknown. Despite the lack of scientific studies, beta-blockers are very commonly used. When matching patients with a similar risk profile in a large heart failure registry, the use of beta-blockers for the treatment of heart failure with a preserved pump function was not associated with any changes in heart failure hospital admissions or cardiovascular death.