Muhammad Reva Aditya, Michael Owen Hogipranata, Artha Maressa Theodora Simanjuntak, Derren David Christian Homenta Rampengan, Kanandya Kizzandy, Wella Karolina, Astrid Pramudya, Hikmawan Wahyu Sulistomo
Hypertension is a leading global health challenge, with growing evidence indicating that gut microbiota dysbiosis plays a role in its pathophysiology. Interventions targeting the gut microbiota, including probiotics, prebiotics, synbiotics, and postbiotics, have emerged as potential therapeutic strategies. This study aims to assess the efficacy of gut microbiota–modulating interventions on systolic and diastolic blood pressure through a systematic review and meta-analysis. We systematically searched PubMed, Scopus, Cochrane Library, ProQuest, and ScienceDirect from inception to July 30, 2025. Thirty-three randomized controlled trials (RCTs) comparing probiotics, prebiotics, synbiotics, or postbiotics against control in hypertensive and pre-hypertensive individuals were included. Data were pooled using a random-effects model to calculate mean differences (MD) and 95% confidence intervals (CI). Overall, interventions significantly reduced both SBP (MD − 3.38 mmHg, 95% CI − 5.62 to − 1.15; p = 0.003) and DBP (MD − 1.54 mmHg, 95% CI − 2.81 to − 0.28; p = 0.02). Synbiotics showed the largest SBP reduction (MD − 5.95 mmHg), while postbiotics significantly lowered DBP (MD − 1.54 mmHg). Prebiotics alone were ineffective. Greater SBP reductions were observed in low- and middle-income countries (LMIC) and among participants not using antihypertensive drugs. DBP reduction was significant only with interventions longer than 3 months. Specific gut microbiota-targeted interventions, particularly synbiotics and postbiotics, are associated with modest but significant blood pressure reductions. These findings support their potential role as adjunctive therapies in hypertension management, especially in specific populations and with adequate treatment duration. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026.
Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Faculty of Medicine, Universitas Sam Ratulangi, Manado, Indonesia; Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Department of Anatomy and Histology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Department of Pharmacology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
