Blood pressure and postnatal growth in preschool children: Korean perspectives

There has been a striking increase in the prevalence of childhood obesity and adult hypertension in recent years, and so the future burden of chronic disease in Korea has become one of the major issues in public health. As a result, concern has increased regarding preventive strategies for hypertension. In longitudinal studies, particularly Korean blood pressure was tracked from childhood to late adolescence. This finding suggests that monitoring and controlling blood pressure in younger subjects are important in order to regulate hypertension risk in Korea. The recognition of fetal programming has raised small body size at birth as a putative risk factor of hypertension. However, subsequent accelerated postnatal growth and adiposity have also been considered to influence later blood pressure level. A Korean study showed that children born with a low birth weight had a greater subsequent weight gain than did those born with a normal weight. There is a correlation between systolic blood pressure and this weight gain during the first 3 years, even in younger subjects. Consistent with the proposed relationship between uric acid level and fetal programming of hypertension, a Korean study has shown a correlation between serum uric acid and blood pressure levels in very young children, and found that levels of uric acid were the highest in those with a low birth weight and subsequent accelerated weight change. Child growth and blood pressure can share some inherited susceptibilities. A significantly higher proportion of children with the angiotensin-converting enzyme genotype II exhibit accelerated growth and high blood pressure levels compared to those with the angiotensin-converting enzyme D genotype. In addition, obese angiotensin-converting enzyme II children have higher blood pressures compared to those with obese and angiotensin-converting enzyme DD genotype. It is difficult to define the essential mechanisms underlying the development of hypertension during the preschool years. However, there is evidence of a relationship between the combined effect of perinatal and postnatal growth patterns, and development of high blood pressure. This also suggests that the genetic susceptibility to hypertension interacts with postnatal growth patterns. These results indicate that high blood pressure can be prevented by monitoring level of blood pressure and controlling postnatal growth patterns from early years of life.