Antihypertensives and Antibiotics: Impact on Intestinal Dysfunction and Hypertension

Hypertension. 2023 Jul;80(7):1393-1402. doi: 10.1161/HYPERTENSIONAHA.122.20073. Epub 2023 Apr 11.


Gut dysfunction has emerged as a contributor to hypertension, the leading risk factor for disease globally, including stroke, heart failure, and kidney disease. This is underpinned by breakdown of the homeostatic relationship connecting intestinal epithelial function, the microbiota and immune responses. Antihypertensive medications have been shown to reverse intestinal dysfunction and gut dysbiosis. However, the mechanisms underlying this restoration of gut structure and function remain largely unknown. In this review, we examine current knowledge supporting a role for impaired intestinal epithelial permeability in hypertension, focusing on electrolyte movement, the renin-angiotensin-aldosterone system, and the restorative effects of orally administered antihypertensive medications and antibiotics. Further work is required to determine if the association between intestinal dysfunction and hypertension is causal. This is a rapidly evolving field, with intestinal dysfunction and dysbiosis representing an area that may be exploited to improve treatment of hypertension and cardiovascular disease.

Keywords: aldosterone; cardiovascular diseases; dysbiosis; electrolytes; renin.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use
  • Dysbiosis / complications
  • Gastrointestinal Microbiome* / physiology
  • Humans
  • Hypertension*


  • Antihypertensive Agents
  • Anti-Bacterial Agents