Associations between gut microbiome and 24-hour blood pressure variability: a cross-sectional study highlighting sex differences and potential therapeutic targets

Abstract 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