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

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7044.1479 (Published 08 June 1996) Cite this as: BMJ 1996;312:1479
  1. Catherine M Law,
  2. Caroline H D Fall,
  3. Christopher N Martyn,
  4. Clive Osmond
  1. Epidemiologist Epidemiologist Clinical scientist Statistician MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD

    EDITOR,—In their study of men in Uppsala, David A Leon and colleagues found that the highest blood pressures were in men who had been small babies but grew to be tall adults.1 They argue that these babies failed to achieve their growth potential in utero. We replicated their analysis in three studies of men born in England (in Hertfordshire (in 1920-30, n = 841), Preston (1935-43, n = 239), and Sheffield (1939-41, n = 170)). Their blood pressures were measured at ages 59-70, 46-54, and 50-53 respectively. Details of the methods have been published.2 3 4

    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 weight was stronger in men who were taller than 176 cm (the median height in Uppsala) and the highest pressures were in men who had been small babies but were tall adults. In Preston and Sheffield, however, the relation between blood pressure and birth weight was not affected by adult height. The mean systolic pressure in men who were taller than 176 cm but had weighed less than 3250 g at birth was 154.2 mm Hg (n = 31), compared with an overall mean of 153.7 mm Hg, in Preston and 140.8 mm Hg (n = 15), compared with an overall mean of 153.7 mm Hg, in Sheffield. There was no trend in systolic or diastolic pressure across the range of 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

    View this table:

    We agree that raised blood pressure in adult life is linked to failure to achieve growth potential in utero. However, the combination of small size at birth with tall adult height indicates failure to achieve growth potential in utero only in a setting where postnatal nutrition is optimal. This may be why the men living in the relatively affluent area of Hertfordshire yield similar results to those living in Uppsala while those living in the industrial areas of Preston and Sheffield do not.

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