Role of foetal programming and epigenetic mechanisms in the pathogenesis of arterial hypertension

Essential hypertension remains poorly understood, despite the enormous efforts of research, which brought understanding of certain physiopathological and treat­ ment mechanisms. New insights have emerged from recent data showing that environmental insults during (in vitro) fertilisation, foetal, perinatal and childhood periods may lead to vascular dysfunction and hyper­ tension later in life (the foetal programming of adult disease hypothesis, also called the “Barker hypothe­ sis”). In line with this hypothesis, we recently reported that apparently young healthy children born after a pregnancy complicated by preeclampsia or born after in vitro fertilisation display a marked generalised vas­ cular dysfunction, which may predispose them to pre­ mature cardiovascular morbidity and mortality. New data from animal studies strongly suggest that epi­ genetic alterations are important underpinning mech­ anisms involved in these vascular abnormalities. Pre­ liminary animal data suggest that pharmacological interventions targeted at these epigenetic modifica­ tions may avoid premature cardiovascular morbidity and mortality.