Early life determinants of adult blood pressure

Purpose of review While treating high blood pressure in middle age is beneficial in terms of reducing the occurence of cardiovascular disease, treated and well controlled hypertensive adults still have a substantial excess mortality and reduced survival compared with normotensives. Therefore, identification of the means of preventing hypertension in earlier life is an important objective. There is increasing evidence that adult blood pressure is determined by a range of characterisitcs from the intrauterine period, through infancy and childhood. The purpose of this review is to provide a summary of the current evidence concerning the early life determinants of adult blood pressure. Recent findings Children from poorer socioeconomic positions, those whose mothers experience pregnancy-induced hypertension, those whose mothers smoke throughout pregnany, those with low birthweight, who are not breastfed, who have high sodium diets in infancy and who are obese in childhood or adolescence tend to have higher blood pressure in adulthood. However the mechanisms linking these early life factors to later blood pressure and the most appropriate means of preventing adult hypertesion by intervening in early life are unclear. Summary There is clear evidence that early life factors are important determinants of adult blood pressure. However, there is a need for randomized trials with sufficient resources for long-term follow-up to assess the effects that interventions such as preventing pregnancy-induced hypertension, reducing maternal, smoking, increasing breast-feeding, reducing salt consumption in infancy and preventing childhood obesity have on adult blood pressure and cardiovascular disiease.