Curhan GC, Willett WC, Rimm EB, Stampfer MJ.
Birth weight and adult hypertension and diabetes mellitus in US
men
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:11A 1996
The hypothesis that low birthweight is associated with the development of
hypertension and diabetes was tested. 22,963 men participating in the Health
Professional Follow-up Study were evaluated. Men weighing less than 5.5 lbs
at
birth had a 24% greater incidence of hypertension and a 1.96-fold increase in
diabetes by age 60. These effects were independent of adult body mass index.
This study points to the importance of developmental factors on the
expression
of disease even decades later in adulthood and have important public health
implications.
Comment: These findings are consistent with other epidemiologic
evidence linking poor
nutrition during pregnancy or low birthweight and adult hypertension. (The
reader is referred to Holiday MA, Pediatric Nephrol 9:5, 1995; Law C, J Hum
Hypertens 9:8, 1995; and Woelk GB, S Afr Med J 85:1348, 1995). Brenner has
postulated that the explanation for this association could be the effect of
poor
nutrition on nephron number in the developing kidney. Nephron number varies
widely in adults; the number may be reduced if maternal nutrition is abnormal
during pregnancy. Animal studies are more convincing of this effect that
human
data. A decreased number of nephrons in the adult could subtly alter renal
sodium excretion, predisposing to the development of hypertension (see
Mackenzie
HS, Brenner BM, Am J Kidney Dis 26:1, 1995).
(Mark S. Paller, M.D., University of Minnesota, Minneapolis)
Weir MJ, Saunders E.
Racial similarity in response to the angiotensin converting enzyme inhibitor
trandolapril.
Blacks have been found to have reduced responses to certain blood
pressure
lowering agents compared with whites (Moser M, J Natl Med Assoc 87 Supple 8:
612, 1995). This effect has been noted for beta-blockers and ACE inhibitors,
particularly for older populations. The angiotensin II receptor blocker
losartan
is also slightly less effective in blacks compared with whites (Goldberg A,
Sweet C, Can J Cardiol 11 Suppl F:27F, 1995). This differential response is
not
seen when small doses of diuretics are added to the regimen.
In this study hypertensives were treated with the ACE inhibitor
trandolapril
for 6 weeks. There was no difference in response in 505 non-black subjects
compared with 322 black subjects. Therefore, at least for this ACE inhibitor
there are no important racial differences in
responsiveness.
(Mark S. Paller, M.D., University of Minnesota)
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11th Scientific Meeting, American Society of Hypertension
H: Pathophysiology :
Genetics