| Objectives Conclusions are currently inconsistent about whether exposure to famine in fetuses affects the risk of developing hypertension in adulthood,and relatively few studies have examined its effect on different blood pressure classifications and blood pressure outcomes.This study provides a theoretical basis for exploring the risk factors of hypertension and different blood pressure classifications and blood pressure outcomes,to provide a theoretical basis for exploring the risk factors of hypertension,identifying high-risk groups as early as possible,and preventing blood pressure increase in a targeted manner.Methods This study adopts a cohort study design,a total of 38941 participants without hypertension in the baseline period(2006)were included in this study,all from the Kailuan cohort.All participants were divided into three groups:non famine exposure group(13592,born from January 1,1963 to December 31,1974 as the reference group for the current analysis),fetal famine exposure group(5578,born from January 1,1959to December 31,1962)and early childhood famine exposure group(19771,born from January 1,1949 to December 31,1958).Cases of hypertension identified between 2006and 2019 by biennial follow-up survey.Then Cox proportional regression analysis was used to analyze the effect of fetal famine exposure on the risk of hypertension.All participants were divided into ideal blood pressure and normal high blood pressure individuals according to the baseline blood pressure level(2006),and the effects of famine exposure on blood pressure outcomes in adulthood were analyzed in two groups of populations,respectively.Results 1 A total of 38,274 analysts were included,including 10,360 women(27.68%)and 27,914 men(72.32%),with an average age of 46.52±2.71 years.After 12.9years of follow-up,there were 13,280 new-onset hypertension cases,the non-famine exposure group(3,925),the fetal famine exposure group(1,906),and the childhood famine exposure group(7,449).The cumulative incidence of hypertension in the total population was 34.70%.The cumulative incidence of hypertension in non-famine exposure group,fetal famine exposure group and childhood famine exposure group were29.38%,34.77%,and 38.33%,respectively,the difference was statistically significant(x~2=256.32,P<0.05).2 After adjusting for mixed factors,compared with the non-famine-exposed group,the results showed that the risk of annual hypertension in the fetal famine-exposed group was increased,HR=1.09,95%CI:1.02～1.17,but in childhood famine exposure this association was not observed in the exposed group,HR=1.02,95%CI:0.93～1.12.3 After stratification by gender,history of diabetes,physical activity,and salt intake.Women(HR=1.26,95%CI:1.09～1.45),diabetes history population(HR=1.11,95%CI:1.03～1.19),not actively exercising(HR=1.09,95%CI:1.02～1.17),and those with high salt intake(HR=1.09,95%CI:1.02～1.17),fetal famine exposure may increase the risk of hypertension.However,this association was not observed in the childhood famine-exposed group.4 After adjusting for mixed factors,compared with the non-famine-exposed group,the results showed that the risk of mild hypertension in the fetal famine-exposed group was increased(HR=1.15,95%CI:1.06～1.25).5 After adjusting for mixed factors,compared with the non-famine-exposed group,the results showed that the risk of isolated systolic hypertension in the fetal famine-exposed group was increased(HR=1.23,95%CI:1.05～1.44).6 In the ideal blood pressure population,the proportion of those who developed from ideal blood pressure to normal high blood pressure in the fetal famine exposure group and the childhood famine exposure group was higher than that in the non-famine exposure group,and the difference was statistically significant.The results of multivariate analysis showed that fetal famine exposure(HR=1.25,95%CI:1.05～1.57)and childhood famine exposure(HR=1.14,95%CI:1.02～1.34)both increased the possibility of ideal blood pressure developing into normal high blood pressure.7 In the normal high blood pressure population,the risk of developing from high normal blood pressure to hypertension in the fetal famine exposure and the childhood famine exposure was higher than that in the non-famine exposure group,and the difference was statistically significant.The results of multivariate analysis showed that fetal famine exposure(HR=1.20,95%CI:1.11～1.47)and childhood famine exposure(HR=1.18,95%CI:1.07～1.43)both increased the possibility of normal high blood pressure developing into hypertension.Conclusions 1 Prenatal famine exposure will increase the risk of hypertension in adulthood,especially among women,those with history of diabetes and with high salt intake.2 Prenatal famine exposure will increase the risk of mild hypertension and isolated systolic hypertension in adulthood.3 Fetal and childhood exposure to famine will increase blood pressure levels in adulthood.Figure 3;Table 13;Reference 139... |
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