Objectives High blood pressure (BP) is associated with diastolic dysfunction, but the consequence of elevated BP over the adult life course on diastolic function is unknown. We hypothesised that high BP in earlier adulthood would be associated with impaired diastolic function independent of current BP.

Methods Participants in the Medical Research Council National Survey of Health and Development birth cohort (n=1653) underwent investigations including echocardiography at age 60–64 years. The relationships between adult BP, antihypertensive treatment (HTT) and echocardiographic measures of diastolic function were assessed using adjusted regression models.

Results Increased systolic BP (SBP) at ages 36, 43 and 53 years was predictive of increased E/e′ and increased left atrial volume. These effects were only partially explained by SBP at 60–64 years and increased left ventricular mass. HTT was also associated with poorer diastolic function after adjustment for SBP at 60–64 years. Faster rates of increase in SBP in midlife were also associated with increased poorer diastolic function.

Conclusions High SBP in midlife is associated with poorer diastolic function at age 60–64 years. Early identification of individuals with high BP or rapid rises in BP may be important for prevention of impaired cardiac function in later life.