SOURCE: Afsar B, Vaziri ND, Aslan G, et al. Gut hormones and gut microbiota: Implications for kidney function and hypertension. J Am Soc Hypertens 2016;10:954-961.

Our primary concerns about hypertension relate to adverse cardiovascular effects. Who would have guessed that the gastrointestinal tract could play an important role?

As an example, glucagon-like peptide-1 (GLP1; agents such as exenatide, liraglutide, etc.) has been shown in animal studies to increase sodium excretion. In type 2 diabetes, GLP1 treatment reduces blood pressure. Indeed, a trial with liraglutide even found a reduction in cardiovascular events.

The microbial population of the gastrointestinal tract also may play a role. Two of the primary bacterial teams of the gastrointestinal microbiome, Bacteroidetes and Firmicutes, have been demonstrated to be elevated in spontaneously hypertensive rats; rebalancing of the flora by antibiotic treatment improved blood pressure.

Alimentary bacteria generate a variety of short-chain fatty acids, some of which can stimulate the sympathetic nervous system and induce renin release from the afferent arteriole. Pharmacologic treatments that address potential toxicities produced by the gastrointestinal microbiome are under study and show some promise.

Although the aphorism “the way to a man’s heart is through his stomach” may have been intended to reflect another agenda, it may turn out to be far more true than most of us expected.