Gut microbiota composition in patients with hypertension and metabolic disorders: A 16S rRNA gene sequencing analysis

Background: Hypertension remains the leading cause of cardiovascular morbidity and mortality. However, conventional risk factors do not fully account for its pathogenesis, particularly in patients with metabolic disorders. While the gut microbiota has emerged as a potential contributing mechanism, data on specific bacterial taxa associated with hypertension in the context of metabolic disorders remain limited in the Russian population. Aim: To analyze the composition and diversity of the gut microbiota in patients with hypertension and metabolic disorders compared to normotensive individuals, and to evaluate the associations between specific bacterial taxa and clinical and hemodynamic parameters. Methods: A single-center observational cross-sectional study was conducted within the prospective ESSE-RF study cohort. From 2021 to 2023, patients with metabolic disorders identified during the 2012–2013 examination (overweight, body mass index ≥ 25 kg/m2, and/or carbohydrate metabolism disorders such as impaired fasting glucose or diabetes mellitus) were invited for a follow-up visit. In all participants, anthropometric, laboratory, and instrumental parameters were assessed; blood pressure and carotid-femoral pulse wave velocity were measured. Microbiota composition was studied by high-throughput 16S rRNA gene sequencing; alpha and beta diversity, differential abundance analysis (DESeq2), and multivariable association analysis (MaAsLin) were performed. Results: The study included 75 patients with metabolic disorders, of whom 44 had hypertension and 31 were normotensive. No statistically significant differences in alpha or beta diversity of the microbiota were found between groups (p 0.05 for all metrics). According to DESeq2, Prevotellaceae NK3B31 group, Ligilactobacillus, and Bifidobacterium were enriched in patients with hypertension, whereas Rhodospirillales incertae sedis, Coriobacteriales incertae sedis, and Turicibacter were enriched in normotensive individuals. The most significant MaAsLin associations were found for Anaerovoracaceae (Clostridia) with systolic blood pressure (p 0.001), Desulfovibrionia (Thermodesulfobacteriota) with diastolic blood pressure (p = 0.004), as well as for Anaerostipes (Lachnospiraceae) and Anaerovoracaceae (Clostridia) with carotid-femoral pulse wave velocity (p = 0.001). In addition, significant associations were found for Eubacterium (Eubacteriaceae) and Eggerthellaceae (Coriobacteriia) with heart rate (p = 0.0004 and p = 0.001, respectively), and for Eubacterium (Eubacteriaceae) and NA Clostridia with antihypertensive therapy (p = 0.001 and p = 0.004, respectively). Conclusion: In patients with hypertension and metabolic disorders, distinct taxonomic features of the gut microbiota were identified, along with statistically significant associations of bacterial taxa with certain hemodynamic and vascular stiffness parameters. Further studies of the microbiota–cardiovascular system interaction should focus specifically on this patient category.