Top Things to Know: Hypertension and the Gut Microbiome: A Science Advisory from the AHA
Published: July 17, 2025
Prepared by Tao Yang, PhD
- Approximately 15–20% of patients with hypertension have treatment-resistant hypertension, highlighting the need for novel approaches to blood pressure management.
- Recent advances in gut microbiome and hypertension research suggest a novel therapeutic opportunity: targeting the gut microbiome to control blood pressure.
- An imbalanced gut microbiome in hypertension increases blood pressure through multiple mechanisms, including disruption of the gut barrier and immune activation, and alterations in gut microbiome-derived metabolites.
- The underlying mechanisms by which gut microbial metabolites contribute to blood pressure regulation require further elucidation; however, gut microbiota-derived uremic toxins may elevate blood pressure by impairing kidney function.
- Salt intake alters the gut microbiota (e.g., depleting Lactobacillus), affects metabolites (e.g., β-hydroxybutyrate, conjugated bile acids), and activates the immune system (e.g., antigen-presenting cells, Th17 cells), all of which contribute to the development of hypertension.
- Preclinical research in rats links gut microbiome changes induced by intermittent fasting to reductions in blood pressure.
- Short chain fatty acids (e.g. acetate, propionate, butyrate) attenuate blood pressure in rodent models. In humans, prebiotic supplements that increase short-chain fatty acid production appear to reduce blood pressure, whereas direct oral butyrate supplementation may raise it.
- Minocycline, an anti-inflammatory antibiotic, lowers blood pressure in rodent models and has demonstrated a significant blood pressure-lowering effect in patients with hypertension.
- Probiotics have been shown to lower blood pressure in both rodent models and patients with hypertension; however, consistent evidence to support specific probiotic strains is lacking.
- Fecal microbiome transplantation temporarily lowers blood pressure in patients with hypertension. Supplementation with prebiotics may enhance the blood pressure-lowering effect. Further research is needed to determine how these and other microbiome-targeted therapies can be effectively translated into clinical practice.
Citation
Yang T, Maki KA, Marques FZ, Cai J, Joe B, Pepine CJ, Pluznick JL, Meyer KA, Kirabo A, Bennett BJ; on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Lifestyle and Cardiometabolic Health. Hypertension and the gut microbiome: A Science Advisory From the American Heart Association. Hypertension. Published online July 17, 2025. doi: 10.1161/HYP.0000000000000247