Diet, Gut Microbiota, and Intestinal Permeability: Emerging Mechanisms in Hypertension Pathogenesis

Hypertension is a leading contributor to global morbidity and mortality, arising from the interplay of genetic and environmental risk factors together with the dysregulation of multiple physiological systems involved in blood pressure control. Recent advances have established the gut as a central regulator, implicating the intestinal microbiota and barrier integrity in the modulation of blood pressure. Alterations in the gut microbial consortium, along with changes in levels of metabolites produced by the microbiota, have been associated with blood pressure regulation in animal models and human studies. Key microbial metabolites, including short-chain fatty acids, trimethylamine-N-oxide, and bile acids influence endothelial function, immune activation, and renal signalling pathways. Concurrently, intestinal permeability facilitates the translocation of microbial products, such as lipopolysaccharides, and triggers systemic inflammation, which leads to renal and vascular dysfunction. Diet plays a pivotal role in shaping microbiome composition and barrier integrity. Western-style diets rich in saturated fats, sugars, and processed additives promote gut dysbiosis and increased permeability, whereas fibre-rich, plant-based diets support microbial diversity, short-chain fatty acid production, and tight-junction integrity. In this review we provide a synthesis of the current evidence that links diet, microbiota, and gut permeability to hypertension, and integrate mechanistic insights from preclinical models with emerging human data. We propose a conceptual framework in which the gut serves as a modifiable target for the prevention and treatment of hypertension. By exploring dietary strategies that restore microbial balance and barrier function, we underscore the potential of integrative, gut-targeted approaches to address a major global health burden.