Department of Medicine, University of Michigan School of Medicine, Ann Arbor (B.P.).
Department of Cardiovascular Diseases, Center for Applied Medical Research and School of Medicine, University of Navarra, Pamplona, Spain (J.D.).
Hypertension. 2024 Jul;81(7):1467-1476. doi: 10.1161/HYPERTENSIONAHA.124.23089. Epub 2024 May 8.
Epidemiological studies have revealed that hypertensive heart disease is a major risk factor for heart failure, and its heart failure burden is growing rapidly. The need to act in the face of this threat requires first an understanding of the multifactorial origin of hypertensive heart disease and second an exploration of new mechanistic pathways involved in myocardial alterations critically involved in cardiac dysfunction and failure (eg, myocardial interstitial fibrosis). Increasing evidence shows that alterations of gut microbiota composition and function (ie, dysbiosis) leading to changes in microbiota-derived metabolites and impairment of the gut barrier and immune functions may be involved in blood pressure elevation and hypertensive organ damage. In this review, we highlight recent advances in the potential contribution of gut microbiota alterations to myocardial interstitial fibrosis in hypertensive heart disease through blood pressure-dependent and blood pressure-independent mechanisms. Achievements in this field should open a new path for more comprehensive treatment of myocardial interstitial fibrosis in hypertensive heart disease and, thus, for the prevention of heart failure.
流行病学研究表明，高血压性心脏病是心力衰竭的一个主要危险因素，其心力衰竭负担正在迅速增加。面对这一威胁，需要首先了解高血压性心脏病的多因素起源，其次需要探索涉及心肌改变的新机制途径，这些改变与心脏功能障碍和衰竭（例如心肌间质纤维化）密切相关。越来越多的证据表明，肠道微生物群落组成和功能的改变（即，生态失调）导致微生物衍生代谢物的变化以及肠道屏障和免疫功能的损害，可能与血压升高和高血压器官损伤有关。在这篇综述中，我们强调了肠道微生物群落改变通过依赖血压和不依赖血压的机制对高血压性心脏病心肌间质纤维化的潜在贡献的最新进展。这一领域的成就应该为更全面地治疗高血压性心脏病中的心肌间质纤维化并因此预防心力衰竭开辟新的途径。
