Gut Dysbiosis and Western Diet in the Pathogenesis of Essential Arterial Hypertension: A Narrative Review.

Maria Paola Canale,Massimo Federici,Manfredi Tesauro,Giulia Marrone,Maria Cantelmo,Nicola Di Daniele,Manuela Di Lauro,Annalisa Noce,Carmine Cardillo

doi:10.3390/nu13041162

Abstract

Metabolic syndrome is a cluster of the most dangerous cardiovascular (CV) risk factors including visceral obesity, insulin resistance, hyperglycemia, alterations in lipid metabolism and arterial hypertension (AH). In particular, AH plays a key role in the complications associated with metabolic syndrome. High salt intake is a well-known risk factor for AH and CV diseases. Vasoconstriction, impaired vasodilation, extracellular volume expansion, inflammation, and an increased sympathetic nervous system (SNS) activity are the mechanisms involved in the pathogenesis of AH, induced by Western diet. Gut dysbiosis in AH is associated with reduction of short chain fatty acid-producing bacteria: acetate, butyrate and propionate, which activate different pathways, causing vasoconstriction, impaired vasodilation, salt and water retention and a consequent high blood pressure. Moreover, increased trimethylamine N-oxide and lipopolysaccharides trigger chronic inflammation, which contributes to endothelial dysfunction and target organs damage. Additionally, a high salt-intake diet impacts negatively on gut microbiota composition. A bidirectional neuronal pathway determines the “brain–gut” axis, which, in turn, influences blood pressure levels. Then, we discuss the possible adjuvant novel treatments related to gut microbiota modulation for AH control.

Highlights

Arterial hypertension (AH) is one of the most important constituents of metabolic syndrome (MetS) and represents a global health problem with implications for public health costs and healthcare personnel involved for its treatment
From 10 to 30% of patients are affected by resistant arterial hypertension (AH), defined as blood pressure (BP) control not achieved by three anti-hypertensive drugs, from different classes, one of which should be a diuretic [18]
We summarize the recent and current literature to further understand the role of Western diet and gut dysbiosis in the pathogenesis and progression of essential AH

Summary

Introduction

Arterial hypertension (AH) is one of the most important constituents of metabolic syndrome (MetS) and represents a global health problem with implications for public health costs and healthcare personnel involved for its treatment. The fibers introduced with the diet are digested by the gut microbiota but not completely hydrolyzed and are metabolized and used by the commensal bacteria of the colon as a source of energy This phenomenon causes the production of intestinal metabolites, called short-chain fatty acids (SCFAs), like acetate, propionate and butyrate. In the case of gut structural alterations associated with a change in the quali-quantitative composition of the microbiota, it is possible to define the condition of “gut dysbiosis”. It is associated with chronic intestinal inflammatory and chronic degenerative non-communicable diseases (CNCDs). We discuss the possible adjuvant novel treatments related to gut microbiota modulation for the AH control

Impact of Western Diet on Arterial Hypertension

Gut Microbiota Qualitative and Quantitative Changes in Arterial Hypertension

Findings

Conclusions