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2020 76:1674–87.Īvery EG, Bartolomaeus H, Maifeld A, Marko L, Wiig H, Wilck N, et al. Microbial peer pressure: the role of the gut microbiota in hypertension and its complications. Muralitharan RR, Jama HA, Xie L, Peh A, Snelson M, Marques FZ. Gut microbiota and inflammation in chronic kidney disease and their roles in the development of cardiovascular disease. Onal EM, Afsar B, Covic A, Vaziri ND, Kanbay M. Thus, antihypertensive intervention strategies targeting the microbiota, such as the use of prebiotics, probiotics, and postbiotics (e.g., SCFAs), are considered new therapeutic options for the treatment of hypertension. Furthermore, the oral microbiota plays a role in BP regulation by producing nitric oxide, which lowers BP via its vasodilatory effects. The drug-metabolizing activities of the microbiota affect the pharmacokinetic parameters of antihypertensive drugs and contribute to the pathogenesis of licorice-induced pseudohyperaldosteronism. In addition, the microbiota may impact the metabolism of drugs and steroid hormones in the host. High-salt intake alters the composition of the microbiota, and this microbial alteration contributes to the pathogenesis of salt-sensitive hypertension. Harmful gut-derived metabolites, such as trimethylamine N-oxide and several uremic toxins, exert proatherosclerotic, prothrombotic, and proinflammatory effects. Metabolites produced by the gut microbiota, especially short-chain fatty acids (SCFAs), modulate BP and vascular responses. In this review, we provide insights into host–microbiota interactions and summarize the evidence supporting the importance of the microbiota in blood pressure (BP) regulation. Dysbiosis, an imbalance in the composition and function of the gut microbiota, was shown to be associated with hypertension in both animal models and humans. Recent evidence suggests that the gut microbiota plays an important role in the development and pathogenesis of hypertension.