News Release 

Early life environment may lead to high blood pressure in children

High outdoor temperatures, low city walkability and BPA exposure associated with higher risk of hypertension in children

American College of Cardiology

Where a mother lives and the temperature outside while she is pregnant, among other environmental factors, can impact whether her child is prehypertensive or hypertensive during childhood, according to a study published today in the Journal of the American College of Cardiology.

Exposure to negative lifestyle factors in pregnancy, such as obesity, physical inactivity, poor diet, and alcohol and tobacco consumption have long been established as heart disease risk factors for mothers. Only in recent years have studies begun to link these risk factors to prehypertensive status in children and their likelihood of developing hypertension, or high blood pressure, later in life.

The study included data from a total of 1,277 mother-child pairs from the Human Early-Life Exposome (HELIX) project, which pooled data of six European birth cohorts from the United Kingdom, France, Spain, Lithuania, Norway and Greece. The selected children were between the ages of 6 to 11, had stored blood and urine samples available and had no prior health problems. At the time of the examination, 10 percent of the children could be classified as prehypertensive or hypertensive.

Researchers evaluated a total of 89 prenatal maternal exposures and 128 postnatal child exposures. Of these, four broader environmental factors were determined to influence blood pressure status in children: Built environment (where the mother was living during pregnancy), outdoor temperature, fish intake and exposure to chemicals.

"This study is the first to simultaneously consider the possible effects of exposure to hundreds of environmental factors during early life on blood pressure in children," said Charline Warembourg, PhD, the study's main author from the Barcelona Institute for Global Health (ISGlobal). "Exposures were assessed through a mix of predictive modeling from home address and questionnaire and through determination of biological samples from the mother and child."

Mothers who lived in a walkable environment with access to green spaces, shops, restaurants and public transportation during pregnancy were associated with normal blood pressure in their children. Alternatively, the mothers who did not live in an urban or highly walkable environment had higher blood pressure. The researchers hypothesized that the lower blood pressure that resulted from living in an urban setting was due to the higher amount of physical activity during pregnancy.

Exposure to a higher outdoor temperature during the time of the blood pressure assessment was associated with lower diastolic blood pressure in children. Outdoor temperature has been proven in previous studies to be a known environmental factor to affect blood pressure in both adults and children.

Both low and high fish intake during pregnancy were associated with an increase in blood pressure in children. While the omega-3 fatty acids found in fish are beneficial for overall cardiovascular health, fish contaminated by chemicals or metals could reduce any positive effects of omega-3 fatty acids.

Exposure to bisphenol-A (BPA) concentrations - a chemical found in various consumer plastics - during pregnancy resulted in higher blood pressure in children, as did exposure to perfluorooctanoate (PFOA) concentrations - a chemical found in cosmetics, household cleaners or clothing. Children who had been exposed to copper during childhood also had a higher blood pressure.

"In this study, the researchers presented a comprehensive analysis of the association of early-life environmental exposures with blood pressure in children," said Andrea A. Baccarelli, MD, PhD, chair and Leon Hess professor of environmental health sciences at the Columbia University Mailman School of Public Health, in an accompanying editorial comment. "Due to the innovation shown by the researchers, this study provides a model that may greatly advance investigations of the influences of environmental exposures on human health."

This study has several limitations, including exposure misclassification and the small sample size given the large number of exposures investigated. While the present study remains at risk of false positives or negatives, it highlights that environmental exposures early in life have potentially important effects on blood pressure in children.

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The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.

The Journal of the American College of Cardiology ranks among the top cardiovascular journals in the world for its scientific impact. JACC is the flagship for a family of journals--JACC: Cardiovascular Interventions, JACC: Cardiovascular Imaging, JACC: Heart Failure, JACC: Clinical Electrophysiology and JACC: Basic to Translational Science--that prides themselves in publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.

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