Blood pressure in childhood : epidemiological probes into the aetiology of high blood pressure
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High arterial blood pressure takes a heavy toll in western populations (1 ). Its causes are still largely unknown, but its sequelae, a variety of cardiovascular and renal diseases, have been referred to as "a modern scourge" (2). High blood pressure of unknown cause, or essential hypertension, is considered by most to be a quantitative deviation from the norm (3). Thus, the study of the distribution, determinants and development of blood pressure may provide knowledge about the aetiology and pathogenesis of high blood pressure. The basic idea of this thesis is, that it is possible to learn something about the causes of essential hypertension by inquiries of the correlates and the course of blood pressure in early life, long before the consequences of high blood pressure have occurred and early enough to prevent them. From this idea the questions follow naturally. What is the level of blood pressure in childhood? Does the level in childhood tell us something about the level in adulthood, when the diseases that are related to high blood pressure occur? What are the determinants, or correlates, of the level of blood pressure? Which factors predict change in blood pressure during childhood? And finally, can future hypertensives be detected early in life? These questions will be dealt with in the following chapters, where reports of various studies are given. The piece de resistance of this thesis are investigations performed as part of the EPOZ study, the Epidemiological Preventive Organisation Zoetermeer. Further studies have been carried out in other populations. The different designs of these studies illustrate that an epidemiologist has many options as a student of disease aetiology. One study is experimental - a randomised trial of sodium intake and blood pressure in newborns. As the experiment serves as the 'gold standard' for any scientific research in epidemiology as well as elsewhere ( 4), I am glad that an experimental study in the open population could be part of this thesis. The other investigations have been non-experimental, observational. Some studies were cross-sectional, others were planned according to a longitudinal research design. The longitudinal studies were of the case-control type and of the follow-up type. And finally, the follow-up studies have been retrospective and prospective. An overview of the various studies, with their design, population and type is given in the Table.
- blood pressure
- sodium intake