Diversity and functionality of the gut microbiota in hypertensive patients from different regions of Peru

<ns3:p> Introduction Arterial hypertension affects around 19.4% of Peruvians over 15 years old, constituting a major public health issue. Recent evidence highlights the gut microbiome’s role in regulating blood pressure through bioactive metabolites that influence inflammation and metabolism. This study aims to characterize the gut microbiota of hypertensive adults from three Peruvian regions, contributing to the understanding of microbial influences on hypertension. Objective To analyze the composition and functionality of the gut microbiota in hypertensive and normotensive adults from different Peruvian regions, considering age, body mass index (BMI), and geographical location. Methods An observational, cross-sectional, and analytical study was conducted with 84 adults (46 hypertensive and 38 normotensive) from nine regions of Peru. Fecal samples underwent metagenomic sequencing of the 16S rRNA gene (V3–V4 region). Alpha and beta diversity were evaluated using the Shannon index, UniFrac distances, and multivariate analyses. Microbial functional pathways were examined to identify potential metabolic differences between groups. Results The dominant phyla in all groups were Bacillota and Bacteroidota. At the genus level, <ns3:italic>Streptococcus</ns3:italic> was associated with hypertensive patients with BMI ≥25, while <ns3:italic>Alistipes</ns3:italic> appeared only in normotensive individuals with BMI <25. Alpha diversity was greater in hypertensive participants under 50 years and with BMI <25, while lower diversity was seen in normotensive adults over 50 and with BMI ≥25. Beta diversity showed partial clustering by hypertension and age, with regional overlap. Functional profiles were similar among groups, mainly involving carbohydrate, amino acid, and lipid metabolism, though BMI and age modulated these patterns. Conclusions Gut microbiota composition and diversity in Peruvian adults are influenced by hypertension, age, BMI, and region. Despite comparable functional profiles, environmental and nutritional factors may have a stronger impact than hypertension alone, offering insight for region-specific prevention and treatment strategies. </ns3:p>