Fetal origins of adult hypertension: a renal mechanism?

It is well-recognized that the etiology of cardiovascular disease includes at least two components: a genetic component and a 'lifestyle' or environme ntal component. However, epidemiological evidence accumulating over the pas t decade has provided an increasingly strong case for the important involve ment of a third component, that of environmental conditions during developm ent (i.e. before birth), in contributing to an individual's overall cardiov ascular risk. Factors in the prenatal environment to which a baby is expose d can cause permanent changes in the structure and function of specific tis sues in the body. Although perhaps valuable in the short term in that they allow survival until birth, these changes are maladaptive in the long term because they predispose the individual to an array of adult diseases. Exper imental data elucidating the possible physiological and morphological mecha nisms by which this perinatal 'programming' for adult cardiovascular diseas e occurs are only just now becoming available. However, it appears that the renin-angiotensin system, and the important role it plays in renal develop ment, may be central in setting the trajectory that leads to cardiovascular disease, and in particular hypertension. Curr Opin Nephrol Hypertens 9:419 -425. (C) 2000 Lippincott Williams & Wilkins.