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(Hypertension. 2003;41:446.)
© 2003 American Heart Association, Inc.

Scientific Contributions

Self-Perpetuating Effects of Birth Size on Blood Pressure Levels in Elderly People

Hilkka Ylihärsilä; Johan G. Eriksson; Tom Forsén; Eero Kajantie; Clive Osmond; David J.P. Barker

From the Hospital for Children and Adolescents, Helsinki University Central Hospital (E.K.), Helsinki; National Public Health Institute (H.Y., J.G.E., T.F., E.K.), Helsinki; University of Helsinki, Department of Public Health (T.F.), Helsinki, Finland; and MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital (C.O., D.J.P.B.), Southampton, United Kingdom.

Correspondence to Prof D.J.P. Barker, MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom. E-mail djpb{at}mrc.soton.ac.uk

It has been suggested that essential hypertension is determined by 2 separate mechanisms: a growth-promoting process in childhood and a self-perpetuating mechanism in adult life. We report a clinical study of 500 people taken from a cohort of 7086 men and women who were born in Helsinki from 1924 to 1933, and whose body size at birth was recorded. As expected, blood pressure levels were inversely related to birthweight and birth length. These associations, however, were confined to the 213 people who had previously been diagnosed as having hypertension. In them, a 1-kg increase in birthweight was associated with a 6.4-mm Hg (95% confidence interval, 1.0 to 11.9) decrease in systolic blood pressure recorded at the clinic, and with a 9.3-mm Hg (95% confidence interval, 2.1 to 16.5) decrease recorded by ambulatory measurement. We conclude that pathological processes initiated in utero become self-perpetuating in adult life and lead to hypertension. Among elderly people with established hypertension, these processes have a strong effect on blood pressure levels, because they are processes that do not respond well to treatment.

Key Words: birthweight • blood pressure • nephron numbers • amplification

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