Factors in the middle age that are associated with the risk for development of diastolic dysfunction in long term are not fully established. The Oulu Project Elucidating Risk of Atherosclerosis OPERA study randomly selected middle-aged subjects with hypertension and age- and gender-matched control subjects (n = 1,045, age 51 ± 6 years, men 49.8%). After >20 years of follow-up, majority of the subjects still alive were available for reexaminations (n = 600). After excluding the subjects with mitral regurgitation, left ventricular ejection fraction <50%, and those from whom echocardiographic septal E/E' could not be reliably measured, the present analysis included 460 subjects. E/E' was divided into 3 subgroups (subgroup 1: E/E' ≤8, subgroup 2: 8 < E/E' < 15, subgroup 3: E/E' ≥15), subgroup 3 suggesting a significant diastolic dysfunction. Several baseline variables were associated with diastolic dysfunction: greater age (p = 0.001), female gender (p = 0.001), shorter height (p <0.001), larger body mass index (p = 0.008), greater systolic blood pressure (p = 0.001), greater pulse pressure (p <0.001), lower baroreflex sensitivity (p = 0.007), lower estimated glomerular filtration rate (p = 0.02), greater atrial natriuretic peptide (p = 0.001), greater fasting plasma glucose (p = 0.001), more common occurrence of diabetes (p = 0.011), and more common usage of antihypertensive medication (p = 0.001). After adjustments in the multivariate model, only systolic blood pressure (p = 0.001), shorter height (p = 0.002), and estimated glomerular filtration rate (p = 0.006) retained a significant association with the risk of developing diastolic dysfunction. In conclusion, greater systolic blood pressure, short height, and lower estimated glomerular filtration rate of the middle-aged subjects were the main determinants of development of diastolic dysfunction during a 20-year follow-up.
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