Increased blood pressure and left ventricular (LV) mass predict the onset of the clinically manifest hypertension, but little is known regarding the possible predictive value of LV function. The present study was designed to evaluate the association between echocardiographic LV long-axis systolic, and diastolic function and hypertension onset. We prospectively followed 244 normotensive adults with a family history of hypertension (HTN), with echocardiography for 7 years. M-mode derived atrioventricular plane displacement of the mitral and tricuspid annuli (MAVPD and TAVPD respectively), and LV circumferential fractional shortening were calculated. Diastolic function of the left and right ventricle were assessed using Doppler indices of the mitral and tricuspid inflow. During follow-up, 79 subjects developed hypertension (H group) and 165 subjects remained normotensive (N group). H group subjects had diminished MAVPD (13.873.4 vs 15.073.1 mm; P ¼ 0.007), lower mitral E/A ratio, and longer mitral E-wave deceleration time as compared to N group. In multivariate Cox model MAVPD and mitral E/A ratio predicted the onset of hypertension independent of LV mass index, blood pressure, pre-hypertensive status at baseline, age, sex and body mass index. During follow-up, H subjects experienced a significant decline in MAVPD and mitral E/A ratio, whereas the indices of right ventricular function and LV circumferential shortening remained intact. In conclusion, alterations in LV long-axis systolic and diastolic function, as measured by MAVPD and E/A ratio predict the onset of hypertension. These parameters declined during the development of hypertension.

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