Gut microbiota in blood pressure control: Friend or foe?

Hypertension is a major global public health issue characterized by complex pathogenesis and a high risk of multiple comorbidities. Gut microbes play a crucial role in blood pressure regulation. This review aims to clarify the roles of distinct gut microbiota compositions in regulating blood pressure and to analyze their potential mechanisms of action in hypertension. Gut microbes produce metabolites that regulate the host immune system, metabolic homeostasis, and other physiological processes, including blood pressure. Key microbial metabolites, such as short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO), have been shown to regulate blood pressure through complex mechanisms. Hypertension disrupts intestinal barrier integrity, allowing inflammatory factors and noxious substances to enter the circulation, creating a vicious cycle between hypertension and gut dysregulation and possibly even inducing other diseases. Current strategies targeting gut microbiota for blood pressure control include fecal microbiota transplantation (FMT) and probiotic supplementation, but further clinical validation of their efficacy and safety is required. In conclusion, the relationship between gut microorganisms and hypertension is intricate and context-dependent, rather than being simply classified as entirely beneficial or detrimental. Future studies should further elucidate the mechanisms of various gut microorganisms regulating blood pressure and explore safer and more effective therapeutic strategies.