Diversity and Functionality of the Gut Microbiota in Hypertensive Patients from Different Regions of Peru

Introduction Hypertension affects approximately 14.2% of people over 15 years of age in Peru, constituting a major public health issue. Recent evidence highlights the gut microbiome’s role in regulating blood pressure through bioactive metabolites that influence inflammation and metabolism. This study aims to characterize the gut microbiota of hypertensive adults from three Peruvian regions, contributing to the understanding of microbial influences on hypertension. Objective To analyze the composition and functionality of the gut microbiota in hypertensive and normotensive adults from different Peruvian regions, considering age, body mass index (BMI), and geographical location. Methods An observational, cross-sectional, and analytical study was conducted with 84 adults (46 hypertensive and 38 normotensive) from nine regions of Peru. Fecal samples were collected for 16S rRNA gene amplicon sequencing of the V3–V4 region. Alpha and beta diversity were evaluated using the Shannon index, UniFrac distances, and multivariate analyses. Microbial functional pathways were examined to identify potential metabolic differences between groups. Results The dominant phyla in all groups were Bacillota and Bacteroidota. At the genus level, Streptococcus was associated with hypertensive patients with BMI ≥25, while Alistipes appeared only in normotensive individuals with BMI <25. Alpha diversity was greater in hypertensive participants under 50 years and with BMI <25, while lower diversity was seen in normotensive adults over 50 and with BMI ≥25. Beta diversity analyses showed substantial overlap across hypertensive status, age, and regional groups, with no clear separation. Adjusted multivariable models confirmed no significant independent association between hypertension status and either alpha or beta diversity after accounting for age, BMI, and region, with region remaining the strongest independent correlate of community composition (R 2 = 16.3%, p = 0.001). Functional profiles were similar among groups, mainly involving carbohydrate, amino acid, and lipid metabolism, though BMI and age modulated these patterns. Conclusions Gut microbiota composition and diversity in this Peruvian cohort were associated not only with hypertension status but also with anthropometric and geographic factors. Despite similar functional profiles between groups, environmental and nutritional context appeared to have a greater influence than hypertension status alone. These exploratory, hypothesis-generating findings should be confirmed in larger, adjusted, longitudinal studies before informing preventive or therapeutic strategies for local settings.