Skip to main content

Advertisement

SpringerLink
Log in

Effects of Probiotics on Patients with Hypertension: a Systematic Review and Meta-analysis

  • Guidelines / Clinical Trials/Meta-Analysis (WJ Kostis, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This meta-analysis and systematic review was conducted to evaluate the effect of probiotics on blood pressure, body mass index (BMI), and blood glucose changes in patients with hypertension.

Recent Findings

We searched the PubMed, Cochrane, Embase, and ProQuest databases using a combination of MeSH and free text, from the inception of these databases to 20 January 2020, with no language restrictions. The quantitative Physiotherapy Evidence Database (PEDro) scale method was used to assess the quality of the included studies. We used the random effects models to estimate the outcomes, with heterogeneity among the studies assessed using Cochran’s Q statistic. Fourteen included studies published between 2002 and 2019 were included in the meta-analysis, reporting results of 846 hypertension participants. A significant reduction in SBP by − 2.05 mmHg (95% CI − 3.87, − 0.24, P = 0.03), DBP by − 1.26 mmHg (95% CI − 2.51, − 0.004, P = 0.047), BMI by − 1.03 (95% CI − 1.28, − 0.97, P < 0.01), and blood glucose by − 0.18 mmol/L (95% CI − 0.30, − 0.05, P = 0.007) was observed following probiotic intervention.

Summary

Our meta-analysis showed a modest but a significant reduction in SBP and DBP in patients with hypertension, particularly in those with diabetes mellitus, following probiotic supplementation. This effect was associated with treatment duration, dosage, and the age of subject, but was not associated with single or multiple strains usage. Additionally, probiotic supplement had a beneficial effect in reducing BMI and blood glucose.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, et al. European Society of Cardiology: Cardiovascular Disease Statistics 2019. Eur Heart J. 2020;41(1):12–85.

    Article  PubMed  Google Scholar 

  2. Yilmaz ZV, Akkas E, Turkmen GG, Kara O, Yucel A, Uygur D. Dietary sodium and potassium intake were associated with hypertension, kidney damage and adverse perinatal outcome in pregnant women with preeclampsia. Hypertens Pregnancy. 2017;36(1):77–83.

    Article  CAS  PubMed  Google Scholar 

  3. Qin X, Huo Y. H-type hypertension, stroke and diabetes in China: opportunities for primary prevention. J Diabetes. 2016;8(1):38–40.

    Article  PubMed  Google Scholar 

  4. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.

    Article  PubMed  Google Scholar 

  5. Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden Of Disease study 2015. Lancet. 2016;388(10053):1659–724.

    Article  Google Scholar 

  6. • Yang T, Richards EM, Pepine CJ, Raizada MK. The gut microbiota and the brain-gut-kidney axis in hypertension and chronic kidney disease. Nat Rev Nephrol. 2018;14(7):442–56 Identifies the mechanism of gut microbiota associated with the development and pathological process of hypertension via brain-gut-kidney axis.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Bartley A, Yang T, Arocha R, Malphurs WL, Larkin R, Magee KL, et al. Increased abundance of lactobacillales in the colon of beta-adrenergic receptor knock out mouse is associated with increased gut bacterial production of short chain fatty acids and reduced IL17 expression in circulating CD4(+) immune cells. Front Physiol. 2018;9:1593.

    Article  PubMed  PubMed Central  Google Scholar 

  8. • Huart J, Leenders J, Taminiau B, Descy J, Saint-Remy A, Daube G, et al. Gut microbiota and fecal levels of short-chain fatty acids differ upon 24-hour blood pressure levels in men. Hypertension. 2019;74(4):1005–13 Identifies the mechanism of gut microbiota associated with hypertension via short chain fatty acids.

    Article  CAS  PubMed  Google Scholar 

  9. • Liu J, Li T, Wu H, Shi H, Bai J, Zhao W, et al. Lactobacillus rhamnosus GG strain mitigated the development of obstructive sleep apnea-induced hypertension in a high salt diet via regulating TMAO level and CD4(+) T cell induced-type I inflammation. Biomed Pharmacother. 2019;112:108580 Identifies the mechanism of gut microbiota associated with hypertension via a important metabolite, trimethylamine-n-oxide.

    Article  CAS  PubMed  Google Scholar 

  10. Khalesi S, Sun J, Buys N, Jayasinghe R. Effect of probiotics on blood pressure: a systematic review and meta-analysis of randomized, controlled trials. Hypertension. 2014;64(4):897–903.

    Article  CAS  PubMed  Google Scholar 

  11. Lewis-Mikhael AM, Davoodvandi A, Jafarnejad S. Effect of Lactobacillus plantarum containing probiotics on blood pressure: a systematic review and meta-analysis. Pharmacol Res. 2020;153:104663.

    Article  CAS  PubMed  Google Scholar 

  12. He J, Zhang F, Han Y. Effect of probiotics on lipid profiles and blood pressure in patients with type 2 diabetes: a meta-analysis of RCTs. Medicine (Baltimore). 2017;96(51):e9166.

    Article  CAS  Google Scholar 

  13. Hendijani F, Akbari V. Probiotic supplementation for management of cardiovascular risk factors in adults with type II diabetes: a systematic review and meta-analysis. Clin Nutr. 2018;37(2):532–41.

    Article  PubMed  Google Scholar 

  14. Feng P, Ye Z, Kakade A, Virk AK, Li X, Liu P. A review on gut remediation of selected environmental contaminants: possible roles of probiotics and gut microbiota. Nutrients. 2018;11(1).

  15. •• Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):2199–269 This comprehensive guideline statement emphasizes the importance of establishing a new diagnosis criteria of hypertension, and the inclusion criteria was refered to it.

    Article  PubMed  Google Scholar 

  16. • Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9, W64. References which were used mostly for their methodological approaches.

  17. • Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60 References which were used mostly for their methodological approaches.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Aihara K, Kajimoto O, Hirata H, Takahashi R, Nakamura Y. Effect of powdered fermented milk with Lactobacillus helveticus on subjects with high-normal blood pressure or mild hypertension. J Am Coll Nutr. 2005;24(4):257–65.

    Article  PubMed  Google Scholar 

  19. Bahmani F, Tajadadi-Ebrahimi M, Kolahdooz F, Mazouchi M, Hadaegh H, Jamal AS, et al. The consumption of synbiotic bread containing Lactobacillus sporogenes and inulin affects nitric oxide and malondialdehyde in patients with type 2 diabetes mellitus: randomized, double-blind, placebo-controlled trial. J Am Coll Nutr. 2016;35(6):506–13.

    Article  CAS  PubMed  Google Scholar 

  20. Esmaeilinezhad Z, Barati-Boldaji R, Brett NR, de Zepetnek JOT, Bellissimo N, Babajafari S, et al. The effect of synbiotics pomegranate juice on cardiovascular risk factors in PCOS patients: a randomized, triple-blinded, controlled trial. J Endocrinol Investig. 2019.

  21. Rabiei S, Shakerhosseini R, Saadat N. The effects of symbiotic therapy on anthropometric measures, body composition and blood pressure in patient with metabolic syndrome: a triple blind RCT. Med J Islam Repub Iran. 2015;29:213.

    PubMed  PubMed Central  Google Scholar 

  22. Firouzi S, Majid HA, Ismail A, Kamaruddin NA, Barakatun-Nisak MY. Effect of multi-strain probiotics (multi-strain microbial cell preparation) on glycemic control and other diabetes-related outcomes in people with type 2 diabetes: a randomized controlled trial. Eur J Nutr. 2017;56(4):1535–50.

    Article  CAS  PubMed  Google Scholar 

  23. Hsieh MC, Tsai WH, Jheng YP, Su SL, Wang SY, Lin CC, et al. The beneficial effects of Lactobacillus reuteri ADR-1 or ADR-3 consumption on type 2 diabetes mellitus: a randomized, double-blinded, placebo-controlled trial. Sci Rep. 2018;8(1):16791.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hutt P, Songisepp E, Ratsep M, Mahlapuu R, Kilk K, Mikelsaar M. Impact of probiotic Lactobacillus plantarum TENSIA in different dairy products on anthropometric and blood biochemical indices of healthy adults. Benefic Microbes. 2015;6(3):233–43.

    Article  CAS  Google Scholar 

  25. Sharafedtinov KK, Plotnikova OA, Alexeeva RI, Sentsova TB, Songisepp E, Stsepetova J, et al. Hypocaloric diet supplemented with probiotic cheese improves body mass index and blood pressure indices of obese hypertensive patients--a randomized double-blind placebo-controlled pilot study. Nutr J. 2013;12:138.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ivey KL, Hodgson JM, Kerr DA, Thompson PL, Stojceski B, Prince RL. The effect of yoghurt and its probiotics on blood pressure and serum lipid profile; a randomised controlled trial. Nutr Metab Cardiovasc Dis. 2015;25(1):46–51.

    Article  CAS  PubMed  Google Scholar 

  27. Naruszewicz M, Johansson ML, Zapolska-Downar D, Bukowska H. Effect of Lactobacillus plantarum 299v on cardiovascular disease risk factors in smokers. Am J Clin Nutr. 2002;76(6):1249–55.

    Article  CAS  PubMed  Google Scholar 

  28. Szulinska M, Loniewski I, Skrypnik K, Auid O, Sobieska M, Auid O, et al. Multispecies probiotic supplementation favorably affects vascular function and reduces arterial stiffness in obese postmenopausal women-a 12-week placebo-controlled and randomized clinical study. Nutrients. 2018;10(11).

  29. Rerksuppaphol S, Rerksuppaphol L. A randomized double-blind controlled trial of Lactobacillus acidophilus plus Bifidobacterium bifidum versus placebo in patients with hypercholesterolemia. J Clin Diagn Res. 2015;9(3):KC01–4.

    PubMed  PubMed Central  Google Scholar 

  30. •• Li J, Zhao F, Wang Y, Chen J, Tao J, Tian G, et al. Gut microbiota dysbiosis contributes to the development of hypertension. Microbiome. 2017;5(1):14 Identifies the mechanism of gut microbiota associated with the development and pathological process of hypertension.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Marques FZ, Nelson E, Chu PY, Horlock D, Fiedler A, Ziemann M, et al. High-fiber diet and acetate supplementation change the gut microbiota and prevent the development of hypertension and heart failure in hypertensive mice. Circulation. 2017;135(10):964–77.

    Article  CAS  PubMed  Google Scholar 

  32. Ufnal M, Jazwiec R, Dadlez M, Drapala A, Sikora M, Skrzypecki J. Trimethylamine-N-oxide: a carnitine-derived metabolite that prolongs the hypertensive effect of angiotensin II in rats. Can J Cardiol. 2014;30(12):1700–5.

    Article  PubMed  Google Scholar 

  33. Islam J, Koseki T, Watanabe K, Ardiansyah, Budijanto S, Oikawa A, et al. Dietary supplementation of fermented rice bran effectively alleviates dextran sodium sulfate-induced colitis in mice. Nutrients. 2017;9(7).

  34. Gomez-Arango LF, Barrett HL, McIntyre HD, Callaway LK, Morrison M, Dekker Nitert M, et al. Increased systolic and diastolic blood pressure is associated with altered gut microbiota composition and butyrate production in early pregnancy. Hypertension. 2016;68(4):974–81.

    Article  CAS  PubMed  Google Scholar 

  35. • Robles-Vera I, Toral M, Romero M, Jimenez R, Sanchez M, Perez-Vizcaino F, et al. Antihypertensive effects of probiotics. Curr Hypertens Rep. 2017;19(4):26 Identifies the mechanism of gut microbiota that could achieve the antihypertension effect and supports our results.

    Article  PubMed  Google Scholar 

  36. Richards EM, Pepine CJ, Raizada MK, Kim S. The gut, its microbiome, and hypertension. Curr Hypertens Rep. 2017;19(4):36.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lamprea-Montealegre JA, Zelnick LR, Hall YN, Bansal N, de Boer IH. Prevalence of hypertension and cardiovascular risk according to blood pressure thresholds used for diagnosis. Hypertension. 2018;72(3):602–9.

    Article  CAS  PubMed  Google Scholar 

  38. •• Lye HS, Kuan CY, Ewe JA, Fung WY, Liong MT. The improvement of hypertension by probiotics: effects on cholesterol, diabetes, renin, and phytoestrogens. Int J Mol Sci. 2009;10(9):3755–75 This paper shows that probiotics could modulate insulin resistance and achieve an antihypertensive effect in diabetes mellitus patients.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Wilkins T, Sequoia J. Probiotics for gastrointestinal conditions: a summary of the evidence. Am Fam Physician. 2017;96(3):170–8.

    PubMed  Google Scholar 

  40. Lee ES, Song EJ, Nam YD, Lee SY. Probiotics in human health and disease: from nutribiotics to pharmabiotics. J Microbiol. 2018;56(11):773–82.

    Article  PubMed  Google Scholar 

  41. Pandey KR, Naik SR, Vakil BV. Probiotics, prebiotics and synbiotics- a review. J Food Sci Technol. 2015;52(12):7577–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Nursing, Jining Medical University, Jining, 272067, Shandong, China

    Cheng Chi, Cheng Li & Wenjun Wang

  2. School of Medicine, Griffith University, Parkland Drive, Gold Coast, QLD, 4222, Australia

    Cheng Chi, Cheng Li, Dongjun Wu & Jing Sun

  3. Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia

    Nicholas Buys

  4. Shanghai East Hospital and School of Medicine, Tongji University, Shanghai, China

    Huimin Fan & Jing Sun

Authors
  1. Cheng Chi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cheng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dongjun Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicholas Buys
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wenjun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Huimin Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jing Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jing Sun.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Guidelines / Clinical Trials/Meta-Analysis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chi, C., Li, C., Wu, D. et al. Effects of Probiotics on Patients with Hypertension: a Systematic Review and Meta-analysis. Curr Hypertens Rep 22, 33 (2020). https://doi.org/10.1007/s11906-020-01041-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-020-01041-5

Keywords

Search

Navigation