Blood pressure regulation in preterms

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The Barker hypothesis in its most general form states that events in fetal and/or early life after birth can change outcomes later in life. There is accumulating information suggesting that prematurity may program later growth and physiology with adverse effects on such variables as pancreatic function and cardiovascular performance. In this issue of The Journal, the report by Bayrakci et al demonstrates a subtle disturbance in blood pressure regulation, primarily in preterms with intrauterine growth restriction. In childhood, preterms and preterms born with growth restriction had normal daytime blood pressure. However, systolic blood pressure was increased at night in the preterm growth restricted group. This lack of the normal circadian decrease in blood pressure indicates a disregulation, which may result in more abnormalities in later life. In these children, homeostatic mechanisms regulate daytime blood pressure to normal values, but this regulation is not maintained at night. Prematurity may alter multiple physiologic systems in subtle ways that do not become apparent until those systems are stressed in later life.