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Perspectives on the involvement of the gut microbiota in salt-sensitive hypertension

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Abstract

Salt-sensitivity hypertension (SSH) is an independent predictor of cardiovascular event-related death. Despite the extensiveness of research on hypertension, which covers areas such as the sympathetic nervous system, the renin-angiotensin system, the vascular system, and the immune system, its pathogenesis remains elusive, with sub-optimal blood pressure control in patients. The gut microbiota is an important component of nutritional support and constitutes a barrier in the host. Long-term high salt intake can lead to gut microbiota dysbiosis and cause significant changes in the expression of gut microbiota-related metabolites. Of these metabolites, short chain fatty acids (SCFAs), trimethylamine oxide, amino acids, bile acids, and lipopolysaccharide are essential mediators of microbe-host crosstalk. These metabolites may contribute to the incidence and development of SSH via inflammatory, immune, vascular, and nervous pathways, among others. In addition, recent studies, including those on the histone deacetylase inhibitory mechanism of SCFAs and the blood pressure-decreasing effects of H2S via vascular activation, suggest that several proteins and factors in the classical pathway elicit their effects through multiple non-classical pathways. This review summarizes changes in the gut microbiota and its related metabolites in high-salt environments, as well as corresponding treatment methods for SSH, such as diet management, probiotic and prebiotic use, antibiotic use, and fecal transplantation, to provide new insights and perspectives for understanding SSH pathogenesis and the development of strategies for its treatment.

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Funding

This work was supported by the Natural Science Foundation of Henan Province (222300420089), the National Natural Science Foundation of China (31971065 and 32371170), and the Scientific Research and Innovation Team of the First Affiliated Hospital of Zhengzhou University (QNCXTD2023006).

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Author notes

  1. These authors contributed equally: Ya-Fan Mu, Zhong-**uzi Gao.

Authors and Affiliations

  1. Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Ya-Fan Mu, Zhong-**uzi Gao, Zi-Hui Mao, Shao-Kang Pan, Dong-Wei Liu, Zhang-Suo Liu & Peng Wu

  2. Institute of Nephrology, Zhengzhou University, Zhengzhou, China

    Ya-Fan Mu, Zhong-**uzi Gao, Zi-Hui Mao, Shao-Kang Pan, Dong-Wei Liu, Zhang-Suo Liu & Peng Wu

  3. Henan Province Research Center for Kidney Disease, Zhengzhou, China

    Ya-Fan Mu, Zhong-**uzi Gao, Zi-Hui Mao, Shao-Kang Pan, Dong-Wei Liu, Zhang-Suo Liu & Peng Wu

  4. Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China

    Ya-Fan Mu, Zhong-**uzi Gao, Zi-Hui Mao, Shao-Kang Pan, Dong-Wei Liu, Zhang-Suo Liu & Peng Wu

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Mu, YF., Gao, ZX., Mao, ZH. et al. Perspectives on the involvement of the gut microbiota in salt-sensitive hypertension. Hypertens Res (2024). https://doi.org/10.1038/s41440-024-01747-y

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