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

Norman M Kaplan, MD
Section Editor
George L Bakris, MD
Deputy Editor
John P Forman, MD, MSc


The pathogenesis of primary hypertension (formerly called "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" and "Neurovascular abnormalities in the pathogenesis of primary (essential) hypertension".)


Babies that are small at birth are more likely to have higher blood pressures during adolescence and to be hypertensive as adults [2]. Small-for-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 [3], diabetes mellitus, and hyperlipidemia [4], frequently in association with abdominal (visceral) obesity (eg, the metabolic syndrome).

The effect of low birth weight upon adult blood pressure was first described in 1988 [5]. The relationship was confirmed in both men and women using data from the Nurses' Health Study and the Health Professionals Follow-up Study [6,7]. Multiple surveys of children also show a relation between birth weight and blood pressure, but of a lesser degree than in adults [8]. 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 [9]. The relationship with adult blood pressure may be even more attenuated [2].

Experimental support for maternal undernutrition causing fetal growth restriction and adult hypertension (and possibly nephrosclerosis) has been provided [9-11]. 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: Feb 2017. | This topic last updated: Aug 02, 2016.
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