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Blood pressure in childhood : epidemiological probes into the aetiology of high blood pressure
- Publication date
- 6 April 1983
- Publisher
- 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.