Raised adult blood pressure linked to failure to achieve growth potential in utero

BMJ 1996;312:1479 (8 June)

Letters

Raised adult blood pressure linked to failure to achieve growth potential in utero

EDITOR,--In their study of men in Uppsala, David A Leon andcolleagues found that the highest blood pressures were in menwho had been small babies but grew to be tall adults.¹ Theyargue that these babies failed to achieve their growth potentialin utero. We replicated their analysis in three studies of menborn in England (in Hertfordshire (in 1920-30, n = 841), Preston(1935-43, n = 239), and Sheffield (1939-41, n = 170)). Theirblood pressures were measured at ages 59-70, 46-54, and 50-53respectively. Details of the methods have been published.² ³⁴

Table 1 shows the results for the men living in Hertfordshire,with the groups as defined by Leon and colleagues. As in Uppsala,the inverse relation between blood pressure and birth weightwas stronger in men who were taller than 176 cm (the medianheight in Uppsala) and the highest pressures were in men whohad been small babies but were tall adults. In Preston and Sheffield,however, the relation between blood pressure and birth weightwas not affected by adult height. The mean systolic pressurein men who were taller than 176 cm but had weighed less than3250 g at birth was 154.2 mm Hg (n = 31), compared with an overallmean of 153.7 mm Hg, in Preston and 140.8 mm Hg (n = 15), comparedwith an overall mean of 153.7 mm Hg, in Sheffield. There wasno trend in systolic or diastolic pressure across the rangeof birth weights in taller men in Preston or Sheffield.

Table 1--Mean systolic and diastolic blood pressure (mm Hg) at age 59-70 by birth weight and height at
examination among men resident in Hertfordshire

                                       Birth weight (g)
---------------------------------------------------------------------------                P value for
                      <3250         3250-           3750-           >/=4250      All men      trend
-------------------------------------------------------------------------------------------------------
Height </=176 cm     (n = 202)     (n = 245)       (n = 138)       (n = 61)      (n = 646)
Systolic               165.5         164.2           162.2)          163.3         164.1         0.12
Diastolic               90.4          90.1            88.3            89.4          89.7         0.07
Height >176 cm       (n = 32)      (n = 70)        (n = 62)        (n = 31)      (n = 195)
Systolic               174.0         164.4           161.5           161.3         164.6         0.03
Diastolic               95.8          90.6            89.7            90.1          91.1         0.07

We agree that raised blood pressure in adult life is linkedto failure to achieve growth potential in utero. However, thecombination of small size at birth with tall adult height indicatesfailure to achieve growth potential in utero only in a settingwhere postnatal nutrition is optimal. This may be why the menliving in the relatively affluent area of Hertfordshire yieldsimilar results to those living in Uppsala while those livingin the industrial areas of Preston and Sheffield do not.

Epidemiologist Epidemiologist Clinical scientist StatisticianMRC Environmental Epidemiology Unit, University of Southampton,Southampton General Hospital, Southampton SO16 6YD

Catherine M Law, Caroline H D Fall, Christopher N Martyn, Clive Osmond

Leon DA, Koupilova I, Lithell HO, Berglund L, Mohsen R, Vagero D, et al. Failure to realise growth potential in utero and adult obesity in relation to blood pressure in 50 year old Swedish men. BMJ 1996;312:401-6. (17 February.) [Abstract/Free Full Text]
Hales CN, Barker DJP, Clark PMS, Cox LJ, Fall C, Osmond C, et al. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ 1991;303:1019-22.
Barker DJP, Bull AR, Osmond C, Simmonds SJ. Fetal and placental size and risk of hypertension in adult life. BMJ 1990;301:259-62.
Martyn CN, Barker DJP, Jespersen S, Greenwald S, Osmond C, Berry C. Growth in utero, adult blood pressure, and arterial compliance. Br Heart J 1995;73:116-21. [Abstract/Free Full Text]

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Failure to realise growth potential in utero and adult obesity in relation to blood pressure in 50 year old Swedish men: David A Leon, Ilona Koupilova, Hans O Lithell, Lars Berglund, Rawya Mohsen, Denny Vagero, Ulla-Britt Lithell, and Paul M McKeigue
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