Implications of Childhood Socioeconomic Environment for Adult Blood Pressure
A UK study has reported a link between relatively low birth weight, manual social class, and higher blood pressure in middle age,[9] supporting the previously proposed hypothesis that the negative effect of birthweight on SBP is initiated in utero.[10] However, the study did not find that the effect was amplified with age, as was also suggested.
Rebecca Hardy, PhD, and colleagues at the Royal Free and University College Medical School London, reviewed a sample of 3634 people from the Medical Research Council (MRC) national survey of health and development, a birth cohort study of men and women born in Britain in 1946. These participants have been followed-up regularly since birth. Blood pressure, height, and weight were measured at ages 36, 43, and 53 years, birth weight was taken from medical records, and childhood social class was defined by the father's occupation when the child was aged 4 years. Mean blood pressures were calculated for categories of birth weight and childhood social class at every age. Multilevel models, with blood pressure as a repeated outcome, were used to test the amplification hypothesis and to compare results for birth weight with those for childhood social class.
Both men and women showed a consistent negative association between birthweight and SBP between the ages of 36 and 53 years. For every 10-year increase in age, SBP was 0.4 mm Hg lower per 1 kg higher birth weight. There was no evidence of such an association with DBP. At all ages, people from a manual social class in childhood had higher SBP and DBP than those from a nonmanual social class. The effect of childhood social class on SBP appeared to increase with age, by 1.0 mm Hg per 10 years, but after allowing for current BMI, which was an increasingly strong determinant of blood pressure, the effect of the father's social class on the change with age was no longer significant. A similar pattern was seen for DBP.
The authors note that current BMI could itself be affected by early life environment. They previously showed, using the same survey data, that the effect of childhood social class on BMI in adulthood was already evident at age 20 years and became greater by 43 years.[11] They suggest that this may come about through the establishment of health-related behaviors or through early life changes to metabolism. They stress the importance of weight control throughout life in the prevention of increasing blood pressure during middle age and that understanding the link between early childhood socioeconomic environment and adult obesity could make weight-control strategies more effective.
Medscape Cardiology. 2003;7(2) © 2003 Medscape
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