Birth Measurements, Family History, and Environmental Factors Associated With Later-Life Hypertensive Status

BACKGROUND This birth cohort study was conducted to investigate the contribution of prenatal and antenatal environmental exposures to later-life hypertensive status. METHODS Two thousand five hundred and three individuals born in 1921-1954 at the Peking Union Medical College Hospital (PUMCH) were targeted; 2,081 (83.1%) participated. Clinical examinations included an interview, blood pressure (BP) measurements, and laboratory assays. Statistical analyses were performed using ordinal regression models with later-life hypertensive status as the dependent variable. Similar analyses were for subpopulations divided by family history of hypertension. RESULTS In the 2,081 subjects, 449 were normotensive, 531 were prehypertensive, and 1,101 had hypertension. Three hundred and forty two hypertensive patients were classified as high-risk (BP >= 180/110 mm Hg, or accompanied with diabetes or three well-established cardiovascular risk factors); the other 759 patients were at mid-to-low risks. Lower birth weight (<2,500 g: odds ratio (OR) = 1.67, P = 0.02; 2,500-<3,000 g: OR = 1.64, P < 0.01; 3,000-<3,500 g, OR = 1.40, P = 0.01), family history of hypertension (OR 1.73, P < 0.01), poor education (OR = 1.76, P < 0.01), and alcoholism (OR = 3.05, P < 0.01) significantly predicted later-life high-risk hypertension. For participants with hypertensive family history (57.7%), the association with birth weight became nonsignificant, but poor education (OR = 2.33, P < 0.01) and alcoholism (OR = 3.10, P = 0.01) remained important. For participants without hypertensive family history (42.3%), the effects of lower birth weight (<2,500 g: OR = 2.26, P = 0.02; 2,500-<3,000 g: OR = 1.91, P = 0.01; 3,000-<3,500 g, OR = 1.78, P = 0.01) and alcoholism (OR = 3.23, P < 0.01) remained significant. CONCLUSION Low birth weight, low education, alcoholism, and hypertensive family history are linked to later-life hypertensive status. Low birth weight is also partly associated with one's genetic background; whereas the association with education and alcoholism are independent from hypertensive family history.