BP has been inversely associated with birth weight in studies worldwide, but few studies have included black individuals. The US National Collaborative Perinatal Project followed 58,960 pregnant women and their resultant offspring for 7 yr. In this post hoc analysis, all term white or black children without kidney or heart disease were included (n ؍ 29,710). The effect of birth weight and other risk factors on systolic (SBP) and diastolic BP (DBP) was evaluated at 7 yr. Mean birth weight and body mass index at 7 yr were slightly lower for black compared with white children (birth weight 3.14 ؎ 0.48 versus 3.32 ؎ 0. L ow birth weight, as an indicator of fetal growth restriction, has been associated recently with a number of chronic diseases in adult life. First widely publicized by Barker (1,2) in Great Britain, the "fetal programming," or "fetal origins of adult disease," hypothesis states that intrauterine compromise results in permanent alterations in fetal physiology. These adaptations may confer a survival advantage on the fetus while in a suboptimal intrauterine milieu but are deleterious to the individual after birth when nutrients and other resources are abundant (3,4). The hypothesized consequence is that growth-restricted neonates develop into children and adults with an increased risk for chronic diseases such cardiovascular disease (5), type 2 diabetes (6), metabolic syndrome (7), and osteoporosis (8).The body of evidence from epidemiologic studies of this hypothesis is largest in support of a relationship between low birth weight and hypertension later in life. A widely referenced meta-analysis of these studies (9) concluded that birth weight is inversely related to BP, most strongly in the pre-and postadolescent periods, but the overwhelming majority of these studies were conducted in primarily white populations, with very little ethnic diversity. Of the 80 studies included in the meta-analysis, only three focused primarily on populations of African descent.While reviewing the literature, we identified two studies of the relationship of size at birth and BP that directly compared black and white individuals. The Alabama Successive Small for Gestational Age Study (10) examined the relationship between intrauterine growth restriction (IUGR) and BP at age 5 yr and found that whereas white children had an inverse relationship between birth weight and BP, black children had a direct association. In contrast, the Bogalusa Heart Study (11) reported on 185 teenagers who were aged 15 to 17 yr and found an inverse