Low Birth Weight as a Risk Factor for Hypertension

While the geographic and demographic disparities in the prevalence of hypertension have been recognized for decades, the reasons for these differences in disease risks remain unknown. The demographic and geographic patterns of hypertension are similar to those of low birth weight, giving support to the “Barker Hypothesis” which proposes a fetal origin of adult‐onset disease. In fact, ecologic and observational studies throughout the world have detected significant associations of low birth weight and increased risks of hypertension. Nonetheless, the mechanisms for the association have not been fully described and documented. With some supportive evidence, proposed mechanisms include reduced nephrogenesis with a higher threshold for pressure natriuresis and greater susceptibility to progressive renal disease, impaired development of the endothelium, and increased sensitivity to glucocorticoids. Still, considerable work needs to be done to explain the birth weight/blood pressure relationship. The findings to date and the clinical significance warrant continued research in this intriguing area of study.