Research has shown that most of the principal causes of mortality in industrialized countries have their roots in early development. Thus, the period from conception through pregnancy to early infancy is uniquely sensitive to long-lasting effects of environmental insults, potentially leading to physiological malprogramming and lifelong disease. Beyond the classical association between low birth weight and increased coronary mortality in adulthood, peri-conceptional and perinatal insults can set the scene for later obesity, cancer and behavioral disorders. Taking the developmental programming of hypertension as an example, this review addresses the remarkably similar mechanisms of early programming, particularly those involving the kidney and vasculature ; the continuum between normality and disease ; the role of early and later nutrition ; and early biomarkers and epigenetic mechanisms of later cardiovascular and metabolic disorders. The developmental origins of adult health and disease represent a global research challenge as emerging countries undergo major nutritional and environmental upheavals. Much research is focused on the benefits of early nutritional and lifestyle interventions, in both animal models and human studies.