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Initiation of hypertension in utero and its amplification throughout life
C M Law1, M de Swiet, C Osmond
1MRC Environmental Epidemiology Unit, Southampton General Hospital.
Insights
Low birth weight is linked to higher blood pressure from infancy through old age. This association, potentially initiated in fetal life, strengthens with age, impacting long-term cardiovascular health.
Area of Science:
- Cardiovascular epidemiology
- Developmental origins of health and disease
Background:
- The relationship between low birth weight and elevated blood pressure is a significant public health concern.
- Understanding when this association originates is crucial for early intervention strategies.
Purpose of the Study:
- To investigate whether the link between high blood pressure and low birth weight begins in utero or infancy.
- To determine how this relationship evolves across the lifespan.
Main Methods:
- A longitudinal study involving children and subsequent follow-up studies in adults.
- Inclusion of participants from various age groups (0-10 years to 59-71 years) with recorded birth weights.
- Systolic blood pressure was the primary outcome measure.
Main Results:
- A consistent inverse relationship between birth weight and systolic blood pressure was observed from infancy onwards.
- The association between birth weight and systolic blood pressure amplified with increasing age.
- For every kilogram increase in birth weight, systolic blood pressure decreased by 5.2 mm Hg in older adults, independent of current body mass.
Conclusions:
- Essential hypertension appears to originate during fetal development.
- The elevated blood pressure associated with low birth weight is amplified throughout life, possibly via a positive feedback mechanism.
Objective:
To determine whether the relation between high blood pressure and low birth weight is initiated in utero or during infancy, and whether it changes with age.
Design:
A longitudinal study of children and three follow up studies of adults.
Setting:
Farnborough, Preston, and Hertfordshire, England, and a national sample in Britain.
Subjects:
1895 children aged 0-10 years, 3240 men and women aged 36 years, 459 men and women aged 46-54 years, and 1231 men and women aged 59-71 years. The birth weight of all subjects had been recorded.
Main Outcome Measure:
Systolic blood pressure.
Results:
At all ages beyond infancy people who had lower birth weight had higher systolic blood pressure. Systolic blood pressure was not related to growth during infancy independently of birth weight. The relation between systolic pressure and birth weight became larger with increasing age so that, after current body mass was allowed for, systolic pressure at ages 64-71 years decreased by 5.2 mm Hg (95% confidence interval 1.8 to 8.6) for every kg increase in birth weight.
Conclusions:
Essential hypertension is initiated in fetal life. A raised blood pressure is then amplified from infancy to old age, perhaps by a positive feedback mechanism.