Blood pressure in prospective population based cohort of newborn and infant twins

BMJ 1994;308:298-302 (29 January)

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Blood pressure in prospective population based cohort of newborn and infant twins

R S Levine, C H Hennekens, M J Jesse

Department of Family and Preventive Medicine, Meharry Medical College, Nashville, TN 37208, USA Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts University of Cincinnati School of Medicine, Cincinnati, Ohio.

Abstract

Objective : To describe blood pressure in twins during infancy.
Design : Prospective study of cohort of twins.
Setting : Teaching hospital in Florida.
Subjects : 166 viable twin pairs born between July 1976 andDecember 1989.
Main outcome measures : Blood pressure and body weight at birth,at 14 days, and at 1, 3, 6, 9, and 12 months.
Results : Both systolic and diastolic pressure correlated withbody weight throughout infancy (at birth r=0.41, P <0.001and r=0.42, P<0.001 respectively; at 1 year r=0.23, P<0.001and r=0.26, P <0.001 respectively). In infants weighing <1500g at birth mean blood pressure rose from about 45/25 mm Hg to101/55 mm Hg from birth to the age of 1 year, while in infantsweighing >3000 g at birth it rose from 63/39 mm Hg to 100/61mm Hg; corresponding mean body weights at 1 year were 7.86 kgand 9.88 kg. Differences in birth weight within pairs of monozygotictwins were negatively correlated with such differences in systolicblood pressure at 1 year (r equal -0.37, P <0.01).
Conclusions : Blood pressure and body weights in twins showedstrongly positive but generally declining correlations throughoutinfancy. Twins of lower birth weight showed a more rapid rateof rise in blood pressure during infancy. At 1 year the catchup in blood pressure exceeded that in body weight. Greater differencesin birth weights between monozygotic twins were associated withsmaller differences in systolic blood pressure at 1 year, suggestingthat intrauterine environmental factors related to birth weightare important in determining blood pressure in infancy.

Clinical implications

Clinical implications
Low birth weight is associated with the development of hypertension in adulthood
In assessing this association it is interesting to see whether the effects of prenatal environment on birth weight and blood pressure are detectable in infancy
This study found that both diastolic and systolic blood pressure correlated with body weight in infant twins throughout the first year of life, although to a declining extent.
Lower birthweight twins showed a more rapid rise in blood pressure during infancy such that at the age of 1 year the catch up in blood pressure exceeded that in body weight
Large differences in birth weight among identical twins were associated with small differences in systolic pressure at the age of 1 year, which suggests that the intrauterine environment is important in determining blood pressure in infancy

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