THE ROLE OF GUT MICROBIOTA IN THE PATHOGENESIS OF HYPERTENSION - NEW PATHOPHYSIOLOGICAL AND THERAPEUTIC PERSPECTIVES

Ewa Bełc; Rafał Borecki; Julia  Kierner; Anna Mamach; Katarzyna  Aleksandrowicz; Zofia  Grodzka; Mateusz  Meszka; Matylda Król; Aleksandra Straszewska; Aleksandra  Woźniak; Patrycja  Sobantka; Szymon Mokrzecki; Karolina  Brzezińska

doi:10.31435/ijitss.3(51).2026.6201

Authors

Ewa Bełc University Clinical Hospital No. 2 of the Medical University of Lodz, Żeromskiego ST. 113, 90-549 Lodz, Poland https://orcid.org/0009-0004-0224-8162
Rafał Borecki Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 251 Pomorska str, 92-213, Lodz, Poland https://orcid.org/0009-0004-3888-0055
Julia Kierner Central Clinical Hospital of UCC WUM, Warszawa, Poland https://orcid.org/0009-0004-2962-3735
Anna Mamach Norbert Barlicki University Clinical Hospital No. 1 in Łódź, Stefan Kopciński 22 Street, 90-153: Łódź, Poland https://orcid.org/0009-0004-5934-8674
Katarzyna Aleksandrowicz Medical University of Lodz: Lodz, Łódź Voivodeship, Poland https://orcid.org/0009-0008-5935-8265
Zofia Grodzka Independent Public Health Care Complex named after Marshal Józef Piłsudski in Płońsk (SPZZOZ): Płońsk, Poland https://orcid.org/0009-0002-0904-810X
Mateusz Meszka Central Teaching Hospital of Medical University of Lodz, Pomorska 251, 92-213 Łódź, Poland https://orcid.org/0009-0001-6147-7000
Matylda Król Copernicus Memorial Hospital, Pabianicka ST. 62, 93-513 Lodz, Poland https://orcid.org/0009-0000-7759-4933
Aleksandra Straszewska Central Teaching Hospital of Medical University of Lodz, Pomorska 251, 92-213 Łódź, Poland https://orcid.org/0009-0003-6293-9689
Aleksandra Woźniak Norbert Barlicki University Clinical Hospital No. 1 in Łódź, Stefan Kopcinski 22 Street, 90-153: Łódź, Poland https://orcid.org/0009-0003-5382-1451
Patrycja Sobantka Central Teaching Hospital of Medical University of Lodz, Poland https://orcid.org/0009-0004-3128-5181
Szymon Mokrzecki Norbert Barlicki University Clinical Hospital No. 1 in Łódź, Stefan Kopcinski 22 Street, 90-153: Łódź, Poland https://orcid.org/0009-0005-8228-2711
Karolina Brzezińska Medical University of Lodz: Lodz, Łódź Voivodeship, Poland https://orcid.org/0009-0008-4403-6060

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6201

Keywords:

Gut Microbiota, Hypertension, Dysbiosis, Gut-Brain Axis, Gut Bacteria

Abstract

Background: Hypertension (HT) is a major cardiovascular risk factor, yet traditional models often fail to explain resistant cases. Recent research shifts the focus to the gastrointestinal tract, positioning gut microbiota as a critical modulator of vascular, renal, and neurological functions.

Objective: This study analyzes the role of gut dysbiosis in HT pathogenesis, focusing on gut-vascular and gut-brain axes. It synthesizes evidence on how bacterial metabolites, epigenetic mechanisms, and chronic inflammation affect blood pressure homeostasis, evaluating diet and probiotics as supportive therapies.

Methods: A review of the current literature in PubMed, Scopus, Google Scholar and ESH/ESC guidelines was conducted, analyzing metagenomic data, animal model studies, and clinical trials regarding the impact of molecular mechanism of metabolic signaling, epigenetic and immunological processes influencing vascular and renal blood pressure regulation.

Results: HT patients exhibit a distinct microbiota phenotype, characterized by an increased Firmicutes/Bacteroides ratio and reduced butyrate-producing bacteria. Key metabolic regulators include protective short-chain fatty acids and prohypertensive trimethylamine N-oxide. It has been demonstrated that leaky gut syndrome leads to the translocation of lipopolysaccharide, which induces systemic neuroinflammation. Furthermore, bacterial metabolites act as epigenetic regulators in the kidneys by modulating the activity of histone deacetylases.

Conclusion: Gut dysbiosis is an active pathophysiological component of HT. The gut-vascular axis integrates pressure control through immunological hormonal, and neuronal mechanisms. Incorporating targeted diets, probiotics, and psychobiotics into standard protocols offers promising new perspective for HT management.

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