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Possible role of low birth weight in the pathogenesis of primary (essential) hypertension

William J Elliott, MD, PhD
Section Editor
George L Bakris, MD
Deputy Editor
John P Forman, MD, MSc


The pathogenesis of primary (formerly "essential") hypertension remains incompletely understood. Among the factors that have been intensively studied include salt intake, obesity and insulin resistance, the renin-angiotensin system, and the sympathetic nervous system. In the past few years, a number of other factors have been evaluated, including genetics, endothelial dysfunction (as manifested by changes in endothelin and nitric oxide), and low birth weight, frequently accompanying preeclampsia [1].

Although this hypothesis is not universally accepted, the data supporting a role for low birth weight in the development of primary hypertension in adulthood are presented in this topic review. Other factors potentially associated with primary hypertension are reviewed separately. (See "Salt intake, salt restriction, and primary (essential) hypertension" and "Obesity and weight reduction in hypertension" and "Low-renin primary (essential) hypertension" and "Genetic factors in the pathogenesis of hypertension".)


Babies who are small at birth are more likely to have higher blood pressures during adolescence and to be hypertensive as adults [2]. Very low birth weight infants (defined as <1500 g) have even higher blood pressures as adults, as seen in an individual-level meta-analysis of 1571 adults from nine worldwide cohorts [3]. Small for gestational age babies are also more likely to have metabolic abnormalities that have been associated with the later development of hypertension and coronary disease including insulin resistance [4], diabetes mellitus, and hyperlipidemia [5], frequently in association with abdominal (visceral) obesity (eg, the metabolic syndrome).

The effect of low birth weight on adult blood pressure was first described in 1988 [6]. The relationship was confirmed in both men and women using data from the Nurses' Health Study and the Health Professionals Follow-up Study [7,8]. In the Nurses' Health Study, low birth weight accounted for 24 percent of the risk of adult hypertension; 64 percent was attributed to unhealthy lifestyle factors [9]. Multiple surveys of children also show a relation between birth weight and blood pressure but of a lesser degree than in adults [10,11]. An analysis of data from four populations across the entire life span demonstrated that for every one-kilogram-higher birth weight, systolic blood pressure was 5.2 mmHg lower at ages 64 to 71 years but only 1 to 3 mmHg lower in adolescence [12]. The relationship with adult blood pressure may be even more attenuated [2].

Maternal undernutrition has been linked to fetal growth restriction and adult hypertension (and possibly nephrosclerosis) in animal experiments [12-14]. The offspring of female rats given a low-protein diet during pregnancy were smaller and developed higher blood pressures than controls as they matured, even though they were fed a normal diet after birth.

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Literature review current through: Oct 2017. | This topic last updated: Oct 18, 2017.
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