Hypertension is the leading risk factor for heart disease and stroke, and is estimated to cause 9.4 million deaths globally every year. The pathogenesis of hypertension is complex, but lifestyle factors such as diet are important contributors to the disease. High dietary intake of fruit and vegetables is associated with reduced blood pressure and lower cardiovascular mortality. A critical relationship between dietary intake and the composition of the gut microbiota has been described in the literature, and a growing body of evidence supports the role of the gut microbiota in the regulation of blood pressure. In this Review, we describe the mechanisms by which the gut microbiota and its metabolites, including short-chain fatty acids, trimethylamine N-oxide, and lipopolysaccharides, act on downstream cellular targets to prevent or contribute to the pathogenesis of hypertension. These effects have a direct influence on tissues such as the kidney, the endothelium, and the heart. Finally, we consider the role of the gut microbiota in resistant hypertension, the possible intergenerational effect of the gut microbiota on blood pressure regulation, and the promising therapeutic potential of gut microbiota modification to improve health and prevent disease.

高血压是心脏病和中风的主要危险因素，据估计每年在全球造成940万人死亡。高血压的发病机制很复杂，但是饮食等生活方式因素是导致该疾病的重要因素。饮食中水果和蔬菜的摄入量高与血压降低和心血管死亡率降低有关。饮食摄入与肠道菌群组成之间的关键关系已在文献中描述，越来越多的证据支持肠道菌群在调节血压中的作用。在本综述中，我们描述了肠道菌群及其代谢产物（包括短链脂肪酸，三甲胺N-氧化物和脂多糖）的机制，作用于下游细胞靶标以预防或促成高血压的发病机理。这些影响直接影响诸如肾脏，内皮和心脏等组织。最后，我们考虑了肠道菌群在抵抗性高血压中的作用，肠道菌群对血压调节的可能的代际效应，以及改良肠道菌群以改善健康和预防疾病的潜在治疗潜力。