Purpose: Arterial hypotension after return of spontaneous circulation (ROSC) from out of hospital cardiac arrest (OHCA) occurs frequently. However, few studies have described post-ROSC hypotension and the relationship with outcome in OHCA. This study aimed to find the prevalence of post-ROSC hypotension and to determine whether post-ROSC hypotension predicts outcome in OHCA. Methods: This was a retrospective cohort study of patients with ROSC (>20 minutes) after OHCA and who were admitted to the emergency department in a tertiary hospital from July, 2005 to June, 2009. Patients` baseline characteristics, presence of arterial hypotension (<90 mmHg), mortality, and neurologic outcome were evaluated. Mortality rates were compared and multivariate logistic regression was used to determine if post-ROSC hypotension independently predicted death. Results: One hundred forty seven patients (93 males) were studied. Post-ROSC hypotension occurred in 108(73%) patients and was associated with significantly higher mortality compared to non-exposure (82% vs. 44% p<0.001). In multivariate logistic regression analysis, post-ROSC hypotension (OR 4.4 [95% CI]) and non-cardiogenic causes (OR 19.7 [95% CI]) were independent predictors of death. Conclusion: Post-ROSC hypotension is common and can be an independent predictor of death in OHCA.