GUT MICROBIOTA AND BLOOD PRESSURE REGULATION: A SYSTEMATIC REVIEW OF MECHANISTIC AND CLINICAL EVIDENCE
DOI:
https://doi.org/10.56238/levv16n54-019Keywords:
Gut Microbiota, Hypertension, Blood Pressure, ProbioticsAbstract
Introduction: Hypertension remains one of the leading modifiable risk factors for cardiovascular morbidity and mortality worldwide. Emerging data indicate that the gut microbiota influences vascular tone, renal sodium handling, and systemic inflammation through metabolites and immune pathways. Clarifying this relationship could open novel avenues for prevention and treatment of hypertension.
Objective: The primary objective was to synthesize mechanistic and clinical evidence linking gut microbiota composition and function to blood pressure regulation. Secondary objectives included identification of key microbial taxa and metabolites, evaluation of probiotic and dietary interventions on blood pressure, comparison of human and animal data, and assessment of evidence certainty using standardized approaches.
Methods: We searched PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP for studies published in the last five years, extending to ten years if fewer than ten eligible human studies were found. Inclusion criteria prioritized human studies assessing gut microbiota or microbiota-modifying interventions with blood pressure outcomes, while mechanistic animal and in vitro studies were considered for biological plausibility. Data were extracted according to PRISMA principles, and the certainty of evidence was appraised with the GRADE framework.
Results and Discussion: Of 1,243 records identified, 21 studies met the inclusion criteria, comprising 12 human studies and 9 mechanistic animal or in vitro investigations. Cross-sectional human data frequently associated reduced microbial diversity and altered taxa with higher blood pressure, while mechanistic studies implicated short-chain fatty acids, salt-sensitive immune modulation, and barrier dysfunction. Probiotic and prebiotic trials demonstrated modest blood pressure reductions, though heterogeneity in strains, dosing, and duration limited firm clinical conclusions.
Conclusion: Current evidence supports a biologically plausible gut microbiota–blood pressure axis with preliminary signals for benefit from microbiota-modifying strategies. Standardization of microbiome methods, adequately powered randomized trials with blood pressure as a primary endpoint, and integration of metabolomics and diet assessments are needed to define clinical utility.
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