The role of intestinal microbiota in the development of arterial hypertension: mechanisms and therapeutic targets

Abstract

The intestinal microbiota not only mediates the influence of a number of risk factors for cardiovascular diseases on the body, but can also play an active role in the regulation of blood pressure (BP) by changing the permeability of the intestinal epithelial barrier and the production of vasoactive metabolites. At the same time, the study of the molecular mechanisms underlying the influence of intestinal microbiota on BP levels is at an early stage. The review analyzes the scientific literature on the role of intestinal microbiota in the development of arterial hypertension (HTN), describes the key mechanisms of the prohypertensive action of intestinal microbiota metabolites, and presents data on new approaches to the treatment of HTN based on effects on the composition and function of intestinal microflora. BP levels are affected by molecules whose concentration in the blood is directly or indirectly related to the activity of intestinal microflora. These bioactive molecules can be divided into two groups — those formed by cells of the human immune system as a result of stimulation by the microbiota and those formed enzymatically as a result of the metabolic activity of the microbiota itself. The first group includes molecular mechanisms associated with immune activation and systemic inflammatory response, and the second group includes short-chain fatty acids, trimethylamine-N-oxide, bile acids, uremic toxins and biogenic amines. HTN is accompanied by specific changes in the composition of the intestinal microbiota, and in recent years, researchers have established cause-and-effect relationships between certain enterotypes and the development of HTN. Moreover, established HTN itself causes changes in the intestinal microbiome profile. A deeper understanding of the molecular mechanisms mediating the influence of microbiota on BP may serve as the basis for the development of new approaches to the treatment of HTN.