Abstract
Objective
In this study, the relationship between bowel habits—particularly constipation—and the response to antihypertensive therapy was evaluated in newly diagnosed patients with essential hypertension. Increasing evidence suggests that the gut microbiota may influence blood pressure through mechanisms such as short-chain fatty acid production, modulation of systemic inflammation, and interaction with the renin–angiotensin–aldosterone system. Since microbiota analyses are costly and not widely applicable, constipation and lifestyle parameters may serve as easily accessible indicators reflecting microbiota health.
Material and Methods
This prospective observational study included 130 patients aged 35-65 years with newly diagnosed and untreated essential hypertension. Participants’ bowel habits, diet, physical activity, and medication use were assessed with a structured questionnaire. A microbiota-friendly lifestyle score (MFLS) was calculated based on the questionnaire responses. Patients were started on monotherapy with either an angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, beta-blocker, or calcium channel blocker. Treatment response was defined as a reduction of ≥10 mmHg in systolic blood pressure at 1-month follow-up.
Results
Constipation was present in 30.8% of participants. The rate of response to antihypertensive therapy was significantly lower in constipated patients (45% vs. 73%, p=0.008). A target reduction in systolic blood pressure was more frequently observed in those with an MFLS score ≥4 (81% vs. 49%, p<0.01). Logistic regression analysis identified constipation [odds ratio (OR): 2.1] and low MFLS score (≤0) (OR: 2.6) as independent predictors of poor treatment response.
Conclusion
Constipation and microbiota unfriendly lifestyle factors are associated with inadequate response to antihypertensive therapy. Therefore, incorporating assessments of bowel habits and lifestyle factors into clinical practice is recommended for optimal management of hypertension.
Keywords: Microbiota, constipation, hypertension
References
Pluznick JL. Gut microbiota in renal physiology: focus on short-chain fatty acids and their receptors. Kidney Int. 2016;90(6):1191-1198.
Yang T, Santisteban MM, Rodriguez V, Li E, Ahmari N, Carvajal JM, et al. Gut dysbiosis is linked to hypertension. Hypertension. 2015;65(6):1331-1340.
Li J, Zhao F, Wang Y, Chen J, Tao J, Tian G, et al. Gut microbiota dysbiosis contributes to the development of hypertension. Microbiome. 2017;5(1):14.
Marques FZ, Mackay CR, Kaye DM. Beyond gut feelings: how the gut microbiota regulates blood pressure. Nat Rev Cardiol. 2018;15(1):20-32.
Gomez-Arango LF, Barrett HL, Wilkinson SA, Callaway LK, McIntyre HD, Morrison M, et al. Low dietary fiber intake increases Collinsella abundance in the gut microbiota of overweight and obese pregnant women. Gut Microbes. 2018;9(3):189-201.
Santisteban MM, Kim S, Pepine CJ, Raizada MK. Brain-gut-bone marrow axis: implications for hypertension and related therapeutics. Circ Res. 2016;118(8):1327-1336.
Durgan DJ, Ganesh BP, Cope JL, Ajami NJ, Phillips SC, Petrosino JF, et al. Role of the gut microbiome in obstructive sleep apnea-induced hypertension. Hypertension. 2016;67(2):469-474.
Wilck N, Matus MG, Kearney SM, Olesen SW, Forslund K, Bartolomaeus H, et al. Salt-responsive gut commensal modulates TH17 axis and disease. Nature. 2017;551(7682):585-589.
