Association between gut microbiome signature and blood pressure in children: findings from a Chinese cohort study

Childhood hypertension is a growing concern, yet its links with the gut microbiome remain poorly understood. We investigated prospective associations between gut microbial co-abundance groups (CAGs), dietary patterns, microbial metabolites, and hypertension risk among 1390 children from the Chinese Adolescent Cohort. Gut microbiota were clustered into CAGs, dietary patterns extracted via partial least squares regression, and associations with incident hypertension assessed using Cox models validated by elastic net regression. CAG1 (dominated by Faecalibacterium and Bacteroides ) and CAG5 ( Romboutsia and Blautia ) were associated with lower hypertension risk (HR = 0.56, 95% CI: 0.41–0.76; HR = 0.64, 95% CI: 0.45–0.91, respectively), whereas CAG3 ( Pseudomonas and Prevotella ) was associated with higher risk (HR = 1.40, 95% CI: 1.15–1.69). A CAG1-associated dietary pattern high in fiber, potassium, and vitamin A but low in sodium was protective. Fecal short-chain fatty acids (SCFAs), including acetic acid (HR = 0.55) and propionic acid (HR = 0.28), were inversely associated with hypertension, mediating 69.6% and 41.4–68.8% of the CAG-hypertension associations, respectively, while CAG1 mediated 82.6% of the dietary pattern’s protective effect. Elastic net regression confirmed the microbiome-SCFA axis as a robust predictor, with acetic acid showing the strongest independent contribution. These findings highlight microbiome-targeted dietary strategies for early cardiovascular prevention.