Mechanisms of disease: In utero programming in the pathogenesis of hypertension

David J.P. Barker, Susan P. Bagby, Mark A. Hanson

Research output: Contribution to journalReview articlepeer-review

223 Scopus citations


Nutritional and other environmental cues during development can permanently alter the structure, homeostatic systems, and functions of the body. This phenomenon has been referred to as 'programming'. Epidemiological and animal studies show that programmed effects operate within the normal range of growth and development, and influence the risk of chronic disease in adult life. We review the evidence that these effects include reduced nephron number and compensatory adaptations, which might lead to hypertension, and perhaps accelerate the decline in renal function that accompanies aging. These processes might be exacerbated by programmed changes in vascular structure and function, and alterations in endocrine and metabolic homeostasis. Programmed effects might be initiated as early as the periconceptual phase of development, and could involve epigenetic changes in gene expression or altered stem cell allocation. Better understanding of these processes could lead to the development of novel diagnostic and preventive measures, and to early detection of at-risk individuals. By monitoring blood pressure, weight, and renal function in children, it might be possible to reduce the risk of cardiovascular and renal disease in later life.

Original languageEnglish (US)
Pages (from-to)700-707
Number of pages8
JournalNature Clinical Practice Nephrology
Issue number12
StatePublished - Dec 2006
Externally publishedYes


  • Birth weight
  • Developmental plasticity
  • Hypertension

ASJC Scopus subject areas

  • Nephrology


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