Gut Microbiota and Hypertension:From Pathogenesis to Therapeutic Potential

Haitao Yang; Jingkun  Liu

doi:10.71321/w9jjqk66

Authors

Haitao Yang Department of Cardiology, The first Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China.
Jingkun Liu Department of Thoracic and Abdominal Radiotherapy, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830011, China.

DOI:

https://doi.org/10.71321/w9jjqk66

Keywords:

Gut microbiota, Hypertension, Microbiota-targeted therapy

Abstract

Hypertension is a major global health burden with high morbidity. Beyond traditional genetic and metabolic factors, increasing evidence shows that gut microbiota dysbiosis plays an important role in the development and progression of hypertension. Clinical studies have revealed that hypertensive patients display reduced microbial diversity, decreased abundance of short-chain fatty acid (SCFA)–producing bacteria, and enrichment of pro-inflammatory taxa such as Prevotella and Klebsiella. These microbial alterations are associated with endothelial dysfunction, chronic inflammation, and activation of the sympathetic nervous system through the gut–brain and gut–kidney axis. Mechanistically, microbial metabolites such as SCFAs, lipopolysaccharide (LPS), and trimethylamine-N-oxide (TMAO) participate in blood pressure regulation by influencing vascular tone, immune responses, and renal sodium handling. Loss of SCFA-producing bacteria decreases nitric oxide bioavailability and impairs vasodilation, while accumulation of LPS and TMAO promotes vascular inflammation and oxidative stress. Disruption of intestinal barrier integrity further exacerbates systemic inflammation, creating a feedback loop that sustains elevated blood pressure. Therapeutically, modulation of gut microbiota through probiotics, prebiotics, dietary interventions, and fecal microbiota transplantation (FMT) has shown promising antihypertensive effects in both animal and human studies. In addition, some antihypertensive drugs can remodel gut microbiota composition, suggesting potential synergistic benefits of combined treatment. In conclusion, the gut microbiota serves as a key and modifiable factor in hypertension pathogenesis. Understanding its mechanisms and therapeutic potential provides novel perspectives for developing microbiota-based and personalized strategies to improve blood pressure control and reduce cardiovascular risk.

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