Heart failure with preserved ejection fraction (HFPEF) is common, and at least half of patients presenting with signs and symptoms of heart failure are found to have preserved left ventricular systolic function. They have high mortality and morbidity and exert a substantial impact on health care costs worldwide. A range of conditions has been shown to predispose individuals to development of diastolic dysfunction and HFPEF. Chronic hypertension is the most common cause; it has been suggested that up to 60% of patients with HFPEF are hypertensive. Coronary artery disease, obesity, and diabetes are some of the other common contributory factors. Early detection of asymptomatic patients identified as at risk of developing this syndrome has the potential to reduce the risk of subsequent heart failure; this may be of benefit to focus our attention on prevention and intervention strategies in this population.