International Journal of Epidemiology 2002;31:1043–1051

Hypertension, one of the most important risk factors for cardiovascular diseases (CVD),1 is the second leading cause of death in China.2 In China, people with hypertension were five times more likely to develop stroke than those with normal blood pressure.3 In Western populations, 30 % of total mortality attributable to CVD could be prevented if blood pressure could be reduced by 10 mmHg.4 Although extensively studied, the aetiology of hypertension cannot be fully explained by genetic factors and adulthood risk factors such as age, body mass index (BMI), physical activity, and cigarette smoking.3,5 It has been suggested that factors related to the intrauterine and postnatal environments may contribute to the development of hyperten-sion.5 Intrauterine development may ‘programme ’ fetal anatomy, physiology, and metabolism and thus may affect the risk of diseases including hypertension in later life.6–8 This hypothesis has been evaluated in animal models and low birthweight (BW) or intrauterine nutrition deficiency was found to be associated with high blood pressure and/or resulted in adult hypertension.9–11 Although the association between BW and blood pressure measurements in childhood or adulthood has been extensively evaluated,12–16 a limited number of epidemiological studies have examined the association of BW with hypertension in adult-hood and the results are not entirely consistent.17–20 Analytical studies on childhood weight or height and adult blood pressure or hypertension are few.18,20 A recent study suggested that accelerated growth between ages 7 and 15 years increases the risk of hypertension in later life.20 The combined effect of BW and childhood growth on hypertension risk in adults is unclear. Using data from the baseline survey of the Shanghai Women’s Health Study (SWHS), we examined the effect of BW and child-hood growth on the risk of adult onset hypertension