The role and mechanism of intestinal flora on blood pressure regulation and hypertension development.

SIGNIFICANCE: Hypertension (HTN) has a complex etiology characterized by genetic and environmental factors. It has become a global health burden leading to cardiovascular diseases and kidney diseases, ultimately progressing to premature death. Accumulating evidence indicated that gut microbiome was associated with metabolic disorders and inflammation, which were closely linked to HTN. Recent Advances: Recent studies using bacterial genomic analysis and fecal microbiota transplantation as well as many lines of seminal evidence demonstrated that aberrant gut microbiome was significantly associated with HTN. The intestinal microbiome of both patients and animals with HTN had decreased bacterial diversity, disordered microbial structure and functions, and altered end products of fermentation. Gut dysbiosis and metabolites of the gut microbiota play an important role in blood pressure control, and are therefore responsible for developing HTN. CRITICAL ISSUES: This study aimed to focus on the recent advances in understanding the role played by gut bacteria and the mechanisms underlying the pathological milieu that induced elevated blood pressure and led to HTN pathogenesis. Potential intervention strategies targeting the correction of gut dysbiosis to improve HTN development were summarized. FUTURE DIRECTIONS: Larger numbers of fecal transplants from participants with HTN should be carried out to examine the magnitude of blood pressure changes with the replacement of gut microbiome. The proposed mechanisms for gut in regulating blood pressure remain to be verified. Whether intervention strategies using probiotics, dietary interventions, bacteriophages, and fecal transplants are feasible for individuals with HTN remains to be explored.