Fetal influences on adult hypertension.

Studies of population samples of adults and children consistently show a relation between lower birthweight and higher subsequent blood pressure (BP). This relation is not present in the neonatal period or in adolescence, which may reflect the unusual dynamics of growth at these times. We suggest that the inverse relation of BP with birthweight is a result of fetal adaptations to an adverse environment, particularly undernutrition. In making these adaptations, long-term physiology or metabolism is changed in a way that leads to subsequent higher BP. Such changes may be in the structure of blood vessels, or the re-programming of influential hormonal axes, such as the pituitary adrenal axis.