Immediate Postnatal Growth Is Associated With Blood Pressure in Young Adulthood

Abstract

Abstract-There is a consistent inverse association between birth weight and systolic blood pressure; however, few studies have been able to examine the immediate postnatal period. We have examined whether accelerated postnatal growth predicts adult systolic and diastolic blood pressure. We followed up participants from the Barry Caerphilly Growth Study. Blood pressure data were obtained on 679 of the original 951 subjects (73%) aged Ϸ25 years. Both multivariable linear regression and spline models were used to examine the association among weight, length, and growth velocities with systolic blood pressure and diastolic blood pressure. Both statistical approaches showed that birth weight was inversely associated with systolic blood pressure. Only the spline models found that immediate (0 to 5 months) weight gain (␤ coefficient: 1.29 mm Hg; 95% CI: 0.36 to 2.23; Pϭ0.007) and weight gain between 1 year and 9 months to 5 years (␤ coefficient: 1.44 mm Hg; 95% CI: 0.31 to 2.57; Pϭ0.01) were independently associated with systolic blood pressure, whereas only immediate weight gain (␤ coefficient: 0.74 mm Hg; 95% CI: 0.08 to 1.41; Pϭ0.03) was associated with diastolic blood pressure. This is the first study to demonstrate that only immediate postnatal growth predicts diastolic blood pressure in term births, whereas it adds further evidence that both birth weight and postnatal growth are associated with systolic blood pressure in support of both the fetal origins and growth acceleration hypotheses. (Hypertension. 2008;52:638-644.)Key Words: blood pressure Ⅲ birth weight Ⅲ cohort study Ⅲ growth and development Ⅲ public health

The Clinical Importance of Nephron Mass

“…123 In a larger study of 19-year-olds who were very preterm, stratified by weight for gestational age, birth weight correlated negatively with serum creatinine and albuminuria and positively with GFR. 124 These results are consistent with those of others, but as has been shown in animal studies, pro- Renal dysfunction Increased renal vascular reactivity 1renal artery response to ␤-adrenergic stimuli and sensitivity to adenylyl cyclase in growth-restricted rats 184,186,187 Altered vascular reactivity 2flow-mediated dilation in LBW children 107,[188][189][190] 1uric acid Endothelial dysfunction Impaired vascular structure and capillary density Altered RAS Administration of inhibitors of RAS abrogates later hypertension 4,30,111,177,191 Administration of angiotensin II causes increased hypertensive response Evidence of expression of AT1R and AT2R and ACE activity are divergent at different stages and in different models of programming Overall, programmed suppression of intrarenal RAS during nephrogenesis and postnatal upregulation of AT1R are most consistent Altered sodium handling 2fractional excretion of sodium 22,109,110,174,192 1expression of BSC1 and TSC 1expression of glucocorticoid receptor 1expression of glucocorticoid responsive ␣1 and ␤1 subunits of Na/K-ATPase 1expression of NHE3 1expression of ␤ and ␥ ENaC Increased sympathetic nervous system activity Renal denervation reduced systolic BP and sodium transporter expression 193 Catch-up growth/obesity Higher BP in children who catch up fastest 98,154 Reduced flow-mediated dilation with higher rate of weight gain AT1R, angiotensin subtype 1 receptor; AT2R, angiotensin subtype 2 receptor; BSC1, bumetanide-sensitive co-transporter; ENaC, epithelial sodium channel; NHE3, sodium hydrogen exchanger; RAS, renin-angiotensin system; TSC, thiazide-sensitive co-transporter.…”

“…[92][93][94][95][96] Consistently, however, BPs are highest in those who were of LBW and exhibited fastest postnatal weight gain, demonstrating the importance of early postnatal nutrition in developmental programming. [97][98][99] Differences in BP between people of LBW and NBW are amplified with age, with the result that LBW adults often develop overt hypertension. 100 The nephron number hypothesis suggests that reduced renal sodium excretory capacity is a link between N glom and hypertension.…”

Renal and extrarenal mechanisms of perinatal programming after intrauterine growth restriction

“…19 In addition, accelerated catch-up growth is associated with higher blood pressure. 20 As a consequence, the International Societies of Paediatric Endocrinology and the Growth Hormone Research Society discourage nutrient-enriched diet in low birth weight infants. Nonetheless, the study does not differentiate between actual IUGR and low birth weight of other origin.…”

Índice de masa corporal y tensión arterial al año de edad según peso al nacer, ganancia de peso y patrones de alimentación temprana

“…Así, el efecto del IMC o de su variación ha sido vinculado con los valores de TA tanto en la adultez, 16,17 como a edades más tempranas. [18][19][20][21][22][23][24] Los trabajos mencionados son consistentes en sus resultados, en términos de la participación de la variación en el peso así como en el efecto del IMC sobre la tensión arterial, algo similar a lo observado en este trabajo. En aquellos estudios en los que se valoraron modelos de análi-sis similares a los aplicados en el presente trabajo se han observado resultados similares, con incrementos de entre 1 y 1,2 mmHg por cada unidad estandarizada de incremento en el peso corporal.…”

“…En aquellos estudios en los que se valoraron modelos de análi-sis similares a los aplicados en el presente trabajo se han observado resultados similares, con incrementos de entre 1 y 1,2 mmHg por cada unidad estandarizada de incremento en el peso corporal. 18,20,24 Este estudio presenta, como fortaleza, la obtención de datos en forma prospectiva, obtenidos mediante técnicas estandarizadas, y con adecuada adherencia al seguimiento por parte de los pacientes.…”