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(Circulation. 2005;111:1932-1937.)
© 2005 American Heart Association, Inc.

Hypertension

Origins of the "Black/White" Difference in Blood Pressure

Roles of Birth Weight, Postnatal Growth, Early Blood Pressure, and Adolescent Body Size: The Bogalusa Heart Study

J.K. Cruickshank, MD; F. Mzayek, MD; L. Liu, MPH; L. Kieltyka, PhD; R. Sherwin, MD; L.S. Webber, PhD; S.R. Srinavasan, PhD; G.S. Berenson, MD

From the Tulane Center for Cardiovascular Health (J.K.C., F.M., L.L., L.K., S.R.S., G.S.B.) and the Departments of Epidemiology (J.K.C., F.M., R.S., S.R.S., G.S.B.) and Biostatistics (L.S.W.), Tulane University Medical Center School of Public Health, New Orleans, La, and the Clinical Epidemiology Group (J.K.C.), University of Manchester Medical School, Manchester, England.

Correspondence to Dr J.K. Cruickshank, Director, Clinical Epidemiology Group, University Department of Medicine, Manchester Royal Infirmary, Manchester M13 9WL, UK. E-mail clinep{at}man.ac.uk

Received November 5, 2004; revision received February 3, 2005; accepted February 28, 2005.

Background— The determinants of differences in blood pressure that emerge in adolescence between black Americans of predominantly African descent and white Americans of predominantly European descent are unknown. One hypothesis is related to intrauterine and early childhood growth. The role of early blood pressure itself is also unclear. We tested whether differences in birth weight and in carefully standardized subsequent measures of weight, height, and blood pressure from 0 to 4 or 5 years were related to black/white differences in blood pressure in adolescence.

Methods and Results— Two Bogalusa cohorts who had complete follow-up data on birth weights and early childhood and adolescent anthropometric and blood pressure measures were pooled. One hundred eighty-five children (48 black and 47 white boys and 41 black and 49 white girls) were followed up and studied after 15 to 17 years. Birth weights were a mean 443 and 282 g lower in black boys and girls, respectively, than in whites (P<0.001). Blood pressures in adolescence were 3.4/1.9 and 1.7/0.6 mm Hg higher, respectively, and tracked from early childhood. In regression analyses, birth weight accounted for the ethnic difference in adolescent blood pressure, which was also independently predicted, in decreasing impact order, by adolescent height, adolescent body mass index, and systolic blood pressure at 4 to 5 years and inversely by growth from 0 to 4 to 5 years.

Conclusions— If these results can be replicated in larger and independent samples, they suggest that efforts to improve intrauterine growth in black infants as well as lessen weight gain in adolescence might substantially reduce excess high blood pressure/hypertension in this ethnic group.

Key Words: blood pressure • birth weight • ethnic groups • pediatrics

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