Associations Between Gut Microbiome and 24-Hour Blood Pressure Variability: A Cross-sectional Study Highlighting Sex Differences and Potential Therapeutic Targets

Blood pressure (BP) variability is an independent risk factor for cardiovascular disease (CVD). While gut microbiota (GM) and GM-derived short-chain fatty acids (SCFAs) are recognized to play a key role in BP regulation, their association with BP variability remains poorly understood. This cross-sectional study of 241 community-dwelling individuals from Hong Kong (113 men and 128 women, mean age 54±6 years) without symptomatic CVD examined the associations of GM, characterized by shotgun sequencing, and plasma SCFAs, with systolic and diastolic blood pressure (SBP/DBP) variability assessed by 24-hour BP monitoring. GM analyses, using covariate-adjusted statistical models, revealed that higher 24-hour SBP CoV associated negatively with GM α-diversity (Shannon and Simpson’s index, P <0.05) and positively with Firmicutes/Bacteroidetes ratio, driven by the female cohort. Parabacteroides merdae , Bacteroides dorei , Bifidobacterium pseudocatenulatum , Alistipes finegoldii and Bacteroides intestinalis were negatively associated with indices of SBP/DBP variability in a sex-specific manner. Further analysis indicated that B. dorei may mediate SBP CoV via plasma iso-butyric acid in women (bootstrapping 95% CI: −3.6 to −0.19; P <0.05). We demonstrated that higher SBP variability is associated with markers of gut dysbiosis and a reduction in beneficial gut bacteria, particularly in women. Notably, we identified several gut bacterial species with potential therapeutic implications for managing 24-hour SBP/DBP variability, warranting further investigation.