Gut microbiota metabolites and insulin resistance parameters as potential indicators of the development and progression of arterial hypertension

BACKGROUND: The steady annual increase in publications in the field of gut microbiota (GM) and insulin resistance indicates a growing recognition of the importance of this research topic.

AIM: To study the characteristics and relationships of GM metabolites and insulin resistance (IR) parameters in patients with arterial hypertension (AH) and to determine their role as indicators of AH progression.

MATERIALS AND METHODS: The comparative study included patients with stage II AGI, aged 25 to 65 years, receiving basic antihypertensive therapy. Patients in the study groups underwent laboratory testing of a biospecimen of blood and feces at the time of hospitalization. Analysis of gut microbiota parameters: the level of TMA, TMAO, short-chain fatty acids (SCFA), endotoxin; biochemical parameters by the lipid profile, fasting glucose, c-peptide, the concentration of C-reactive protein, gomocistein were determined; 24-hour blood pressure (BP) monitoring was performed by BPLaB device, Russia; study of the elastic properties of the vascular wall by sphygmography using the Vasera VS-1000 Series, PWV — pulse wave velocity (PWV). Statistical analysis was carried out using the IBM SPSS Statistics 21 application package.

RESULTS: The study included 161 patients who met the inclusion criteria, from which 3 main groups were formed: group 1 — persons without AH (n=45); group 2 — patients with stage I-III AH (n=53); group 3 — patients with stage I-III AH and abdominal obesity (AO) (n=63), matched by age, gender and therapy. Patients in group 3 differed significantly from patients in groups 1 and 2 in terms of BMI, WC, OB, and from group 1 in the values of office SBP, DBP (p < 0.001) and pulse wave velocity (PWV) (p=0.015). The levels of TMAO and endotoxin were also significantly higher in the 3rd group of patients compared to the 1st group. The total content of monocarboxylic acids: C2 — acetic acid, C3 — propionic acid, C4 — butyric acid is significantly higher in the 2nd and 3rd groups compared to the 1st group (p < 0.002, p < 0.004, respectively to the groups). In the groups with AH, the target level of TC and LDL-C indicators was significantly exceeded, and in the group of AH with AO — the maximum level of TG p=0.001, TyG index, interleukin 1β and hs-CRP (p=0.001). The dependence of PWV on SCLC2 and TyG C2 and SBP on TyG in the 3rd groups of patients was determined using the logistic regression method.

CONCLUSION: The close relationship between the TyG index and UA metabolites with PWV and SPB parameters may confirm the complex role of these factors in the development and progression of AH, especially in the presence of AO. The introduction of these diagnostic methods into clinical practice will facilitate the implementation of early preventive and therapeutic intervention strategies.

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