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(Hypertension. 2004;44:811.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Fetal and Early Life Determinants of Hypertension in Adults

Implications for Study

From the Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston.

Correspondence to Daniel T. Lackland, DrPH, Department of Biometry and Epidemiology, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425. E-mail lackland@musc.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In this issue of Hypertension, Fagerudd et al present results describing the significant association of early life factors and adult blood pressure levels.¹ The concept that adult-onset diseases may have a fetal and/or early life origin has been advanced since the 1980s.² This school of thought, also referred to as the "Barker Hypothesis," was initiated by identifying ecological associations of fetal and early life health indicators (infant mortality, birth size, etc) and adult diseases, such as ischemic heart disease.² This epidemiological approach was used to assess the geographic patterns of birth weight and adult-onset stroke in the United States and the United Kingdom, identifying similar associations.³ The results prompted the expansion to numerous cohort and epidemiological studies that identified the direct association of birth weight and various disease outcomes, indicating greater disease risk and accelerated disease progression among individuals with adverse fetal and early life events. For example, risk for hypertension-related end-stage renal disease was greater among individuals with a birth weight <2500 grams.⁴ Similar findings were reported for hypertension and other hypertension-related outcomes.⁵

Clearly, indicators such as birth weight and birth length are influenced by fetal exposures to various maternal factors. Most obvious, maternal nutrition is suggested as a major factor with maternal undernutrition and malnutrition playing a major role.² The associations are even greater when low birth weight is coupled with childhood obesity. Greatest risks of hypertension are identified for low-birth-weight individuals with accelerated excess "catch-up weight."⁶ The identification of such factors associated with cardiovascular disease provides . . . [Full Text of this Article]

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