The relationship of hypertension and gut microbiota in child patients

INTRODUCTION AND PURPOSE: Hypertension is a multifactorial disease for which no single etiology or pathophysiological mechanism is responsible because there are many factors that determine blood pressure and interact with each other. It is thought that the functional and compositional changes of the microbiota are associated with many diseases. In recent studies, it has been reported that the changing gut microbiota plays a role in the development of many diseases such as obesity, colorectal cancer, inflammatory bowel diseases, and hypertension. The link between the microbiota and blood pressure is rather mixed. It is thought that the microbiota may affect blood pressure directly or indirectly. With the change in the amount of intestinal bacteria; Increase in lipid hydrolysis, increase in calorie intake, increase in glucose reabsorption, increase in gastrin secretion, increase in TMAO and decrease in short-chain fatty acids occur. With the complex mechanisms caused by all these, it leads to the development of hypertension. The pathogenesis of hypertension, which is one of the preventable metabolic diseases, has not been fully elucidated, and it is thought that it is affected by multiple etiological factors and microbiota changes may be one of them. In this study, we aimed to determine the difference by comparing the intestinal microbiota of individuals with primary hypertension and healthy individuals. MATERIAL/METHOD: The study was conducted between April 2021 and April 2022 with 20 healthy children under the age of 18 who applied to the Pediatric Polyclinic of Manisa Celal Bayar University Faculty of Medicine, and 20 primary children under the age of 18 who applied to the Pediatric Nephrology Polyclinic of Manisa Celal Bayar Faculty of Medicine, conducted among patients with hypertension. All statistical analyzes were performed using the SPSS 23.0 package program. RESULTS: 20 healthy controls and 20 children with hypertension under 18 years of age were included in the study. In the study, no significant difference was found in terms of demographic characteristics such as age, height, weight and BMI (p>0.05). When the background characteristics of the patients were questioned, no significant difference was found between the patient and control groups in terms of delivery type and week of delivery (p>0.05). When the familial characteristics of the patients were questioned, the presence of HT in the families of hypertensive children was found to be statistically more significant (p<0.05). When the treatment methods used by the patients were evaluated, it was found that all of them were treated with non-pharmacological methods, those who received pharmacological treatment were mostly under control with monotherapy, and the most commonly used drug group was ACEI. When the laboratory results in the patient group were examined, uric acid elevation was found in most of the patient group, while an elevated lipid profile and proteinuria in the 24-hour urine were found in a minority of them. When hypertension patients were examined in terms of end-organ damage, renal damage was not observed in any of them, while LVH was detected in 45% and HTRP in 5%. When the microbiota diversity of the patient and control groups was compared; In all taxonomic units (kingdom, branch, class, order, family, genus) diversity was found to be significantly less in the patient group (p<0.05) When the patient and control groups were evaluated at the kingdom level, Bacteriodes and Firmicutes were found to be significantly higher in the control group, while Proteobacteria and Firmicutes/ Bacteriodes rate was found to be significantly higher in the patient group (p<0.05). When evaluated at the class level, the rate of negativicutes was significantly lower in the patient group, while the rate of enterobacteriaceae was found to be high in the patient group when evaluated at the family level (p<0.05). When the Shannon and Simpson index of the patient and control groups were evaluated, it was found to be lower in the patient group and statistically significant (p<0.05). CONCLUSION: In our study, data showing the diversity of microbiota between healthy individuals and hypertensive individuals are presented. The decrease in microbiota diversity in hypertensive individuals emphasizes the importance of dysbiosis. In the light of these findings, hypertension can be prevented by preventing dysbiosis and new treatment modalities can be developed.