Gut microbiota as a driver of variable antihypertensive drug response: A narrative review

Hypertension is a major global burden to human health. Despite the availability of multiple classes of antihypertensive medications, a considerable number of patients still have uncontrolled or treatment-resistant hypertension. The gut microbiota is increasingly recognized as a regulator of blood pressure, and fecal microbiota transfer from hypertensive patients has been shown to increase blood pressure in experimental rodent recipients. Although antihypertensive medications remain the mainstay of treatment and are more readily applicable than microbiota-based therapies, gut microbiota may influence how these medications work. Gut microbes contain diverse enzymes involved in drug metabolism and can also affect host physiology in response. Emerging research has identified the gut microbiota as an important modifier of therapeutic drug efficacy. In this review, we summarize the current evidence supporting the role of the gut microbiota as a modifier of antihypertensive drug response. We also propose that future studies focus on identifying gut microbial features and bacterial species that may be used to improve the blood pressure-lowering efficacy of antihypertensive medications.