Meeting NewsPerspective

Indicators in gut microbiome may lead to better diagnosis, treatment of high BP

Analyzing bacteria in the gut, researchers have determined that patients presenting with hypertension plus depression may have an entirely different disease than those with hypertension alone, according to preliminary research presented at the American Heart Association’s 2019 Hypertension Scientific Sessions.

This assessment may one day lead to targeting the gastrointestinal tract as a means to prevent, diagnose, and treat hypertension in patients with or without depression,” Bruce R. Stevens, PhD, professor of physiology and functional genomics, medicine, and psychiatry at the University of Florida College of Medicine, said during a presentation.

The discovery arose from the Florida team's newly developed machine learning technology involving unique amplicon sequence variants of gut bacterial genes, combined with whole genome metagenomic shotgun sequence analyses of microbiome data from stool samples of 95 volunteers.

“We believe we have uncloaked two new forms of high blood pressure. One mechanism, which we call 'depressive-hypertension', may be a completely different pathophysiological state than 'non-depressive-hypertension', which are each different from 'non-hypertensive depression,’” Stevens said.

“People are ‘meta-organisms’ made up of roughly equal numbers of human cells and bacteria. We have co-evolved with gut bacteria ecology interacting bidirectionally with our bodily physiology and brains. Interactions involving particular bacterial species and their metabolic pathways may steer some people towards developing high BP with depression via brain neuroinflammation of connections between mood and BP regulation brain centers coupled with effects on vascular stiffness resulting from gut metabolites, intestinal epithelium and cardiovascular-renal physiology,” Stevens told Healio.

Gut microbiome metabolism influences personal physiology, Stevens said, noting that for example, the antimicrobial actions of certain antihypertensive and antidepressant drugs can control particular gut bacteria, and thereby impact the renin-angiotensin-aldosterone system components which are recapitulated in entirety within the gastrointestinal tract wall.

"The findings help explain how the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets benefit hypertension and depression by promoting good-guy gut microbiome ecology that yields cardiovascular benefits to their human hosts," Stevens told Healio. – by Scott Buzby

Reference:

Stevens, BR, et al. Presentation 019. Presented at: American Heart Association Hypertension Scientific Sessions; Sept. 5-8, 2019; New Orleans.

Disclosure: The authors report no relevant financial disclosures.

Analyzing bacteria in the gut, researchers have determined that patients presenting with hypertension plus depression may have an entirely different disease than those with hypertension alone, according to preliminary research presented at the American Heart Association’s 2019 Hypertension Scientific Sessions.

This assessment may one day lead to targeting the gastrointestinal tract as a means to prevent, diagnose, and treat hypertension in patients with or without depression,” Bruce R. Stevens, PhD, professor of physiology and functional genomics, medicine, and psychiatry at the University of Florida College of Medicine, said during a presentation.

The discovery arose from the Florida team's newly developed machine learning technology involving unique amplicon sequence variants of gut bacterial genes, combined with whole genome metagenomic shotgun sequence analyses of microbiome data from stool samples of 95 volunteers.

“We believe we have uncloaked two new forms of high blood pressure. One mechanism, which we call 'depressive-hypertension', may be a completely different pathophysiological state than 'non-depressive-hypertension', which are each different from 'non-hypertensive depression,’” Stevens said.

“People are ‘meta-organisms’ made up of roughly equal numbers of human cells and bacteria. We have co-evolved with gut bacteria ecology interacting bidirectionally with our bodily physiology and brains. Interactions involving particular bacterial species and their metabolic pathways may steer some people towards developing high BP with depression via brain neuroinflammation of connections between mood and BP regulation brain centers coupled with effects on vascular stiffness resulting from gut metabolites, intestinal epithelium and cardiovascular-renal physiology,” Stevens told Healio.

Gut microbiome metabolism influences personal physiology, Stevens said, noting that for example, the antimicrobial actions of certain antihypertensive and antidepressant drugs can control particular gut bacteria, and thereby impact the renin-angiotensin-aldosterone system components which are recapitulated in entirety within the gastrointestinal tract wall.

"The findings help explain how the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets benefit hypertension and depression by promoting good-guy gut microbiome ecology that yields cardiovascular benefits to their human hosts," Stevens told Healio. – by Scott Buzby

Reference:

Stevens, BR, et al. Presentation 019. Presented at: American Heart Association Hypertension Scientific Sessions; Sept. 5-8, 2019; New Orleans.

Disclosure: The authors report no relevant financial disclosures.

    Perspective
    Willie E. Lawrence Jr.

    Willie E. Lawrence Jr.

    Historically, when someone presents with hypertension, we have an algorithm, and in the past, we would randomly choose medications to manage hypertension, not taking note of or completely understanding the differences in hypertension. Hypertension has been labeled 'essential hypertension,' which means we don't necessarily understand the mechanisms. These kinds of studies help to perhaps better understand the mechanisms of hypertension in individuals. It helps clinicians  to begin to take more of an individualized, personalized approach to the management of hypertension. Perhaps through analysis and use of big data, down the road, we can take a more personalized approach to hypertension. We'll take into account not only people's phenotypes, how they look, but also their genotype, their genetic makeup, their ethnic makeup and even maybe the genetic makeup of the flora in the gut, which is what becomes even more exciting.

    This study is more observational than not, and I must admit, I'd never thought about combining assessments of hypertension as it relates to depression. But I think it's an important initial observation. It needs further assessment. As a cardiologist, I don't know quite as much about the microbiome and the testing per se, but I think it's provocative in that it gets us to thinking about different ways to look at an old disease and to not just assume what the pathways are, especially in patients who may show resistance to typical treatment approaches. But in looking for other explanations for why these types of resistances exist, they could certainly be related to the GI tract; based upon our knowledge of how things like sodium is handled differently in different populations, in knowing that there are specific models showing that these differences are based upon things that are going on in the GI tract, not in the kidneys.

    So, I think this process of discovery and answering questions is exciting. I commend these folks who asked a question that I would never have thought of. There are people out there who are trying to put this puzzle together and hopefully it'll give us some insight into treatment of an important disease, a disease that affects maybe half of the people in this country, more than 60% of African Americans and more and more people as they age.

    • Willie E. Lawrence Jr., MD, FAHA, FACC
    • Chief of Cardiology, Research Medical Center
      Midwest Heart & Vascular Specialists
      Kansas City, MO

    Disclosures: Lawrence reports no relevant financial disclosures.

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