American Journal of Hypertension Research
ISSN (Print): ISSN Pending ISSN (Online): ISSN Pending Website: Editor-in-chief: Vasilios Kotsis
Open Access
Journal Browser
American Journal of Hypertension Research. 2019, 6(1), 1-7
DOI: 10.12691/ajhr-6-1-1
Open AccessReview Article

Endothelial Dysfunction and Hypertension in African Americans: Overview of the Role of the Gut Microbiome

Marc D. Cook1, , Lanna Anderson2, Maitha Aldokhayyil3, Adelola Adeyemo3, Mesha Guinyard2 and Michael Brown3

1North Carolina Agriculture and Technology State University, Department of Kinesiology, Greensboro, NC

2North Carolina Agriculture and Technology State University, Department of Biology, Greensboro, NC

3Auburn University, School of Kinesiology, Auburn, AL

Pub. Date: June 24, 2019

Cite this paper:
Marc D. Cook, Lanna Anderson, Maitha Aldokhayyil, Adelola Adeyemo, Mesha Guinyard and Michael Brown. Endothelial Dysfunction and Hypertension in African Americans: Overview of the Role of the Gut Microbiome. American Journal of Hypertension Research. 2019; 6(1):1-7. doi: 10.12691/ajhr-6-1-1


Hypertension (now defined by systolic blood pressure/diastolic blood pressure [SBP/DBP] greater than 130/90 mmHg), is one of the most common cardiovascular disorders and is a critical public health and economic concern. African Americans have the greatest burden of hypertension and elucidating the causes of this racial disparity is important for amending and developing effective treatment strategies. Although studies have provided mechanistic insight concerning characteristics of endothelial dysfunction, which likely precedes hypertension in African Americans, our knowledge is limited concerning internal systems (i.e., gut) that may affect endothelial and vascular health outcomes. Recent studies report that the types, and balance, of microbes in the gut are significant contributors to health and disease. Gut microbial dysbiosis, an unhealthy and poorly diverse gut microbial profile, has been linked to hypertension and other diseases that may disproportionately affect cardiovascular health. Relative to hypertension, dysbiosis has been characterized as a reduced richness of short chain fatty acid (SCFA) producing microbes. SCFAs are significant metabolites produced by gut microbes beneficially impact cellular functions, specifically vascular smooth muscle and endothelial cells. Studies concerning the gut microbiome and cardiovascular disease are limited in humans and grossly underrepresent minority populations. This brief review will overview factors concerning the racial disparity in hypertension and provide insight into the potential role that gut dysbiosis may have in hypertension, highlighting the “gut-vascular axis” concerning cardiovascular health.

racial disparity endothelial dysfunction hypertension gut dysbiosis short-chain fatty acids

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Kjeldsen, S.E., Hypertension and cardiovascular risk: General aspects. Pharmacol Res, 2018. 129: p. 95-99.
[2]  Dad, T. and D.E. Weiner, Stroke and Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management Across Kidney Disease Stages. Semin Nephrol, 2015. 35(4): p. 311-22.
[3]  Lawes, C.M., et al., Blood pressure and stroke: an overview of published reviews. Stroke, 2004. 35(4): p. 1024.
[4]  System, U.S.R.D., Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, in USRDS Annual Data Report. 2009, National Institute of Diabetes and Digestive and Kidney Disease.
[5]  Murray, C.J., et al., The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA, 2013. 310(6): p. 591-608.
[6]  Mills, K.T., et al., Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation, 2016. 134(6): p. 441-50.
[7]  Egan, B.M., et al., Hypertension in the United States, 1999 to 2012: progress toward Healthy People 2020 goals. Circulation, 2014. 130(19): p. 1692-9.
[8]  Fryar, C.D., et al., Hypertension Prevalence and Control Among Adults: United States, 2015-2016. NCHS Data Brief, 2017(289): p. 1-8.
[9]  Egan, B.M., Y. Zhao, and R.N. Axon, US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA, 2010. 303(20): p. 2043-50.
[10]  Heidenreich, P.A., et al., Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation, 2011. 123(8): p. 933-44.
[11]  Kirkland, E.B., et al., Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003-2014. J Am Heart Assoc, 2018. 7(11).
[12]  Carnethon, M.R., et al., Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. Circulation, 2017. 136(21): p. e393-e423.
[13]  Ferdinand, K.C. and R.R. Townsend, Hypertension in the US Black population: risk factors, complications, and potential impact of central aortic pressure on effective treatment. Cardiovasc Drugs Ther, 2012. 26(2): p. 157-65.
[14]  Muntner, P., et al., Trends in blood pressure among children and adolescents. JAMA, 2004. 291(17): p. 2107-13.
[15]  Kalinowski, L., I.T. Dobrucki, and T. Malinski, Race-specific differences in endothelial function: predisposition of African Americans to vascular diseases. Circulation, 2004. 109(21): p. 2511-7.
[16]  Hozawa, A., et al., Absolute and attributable risks of cardiovascular disease incidence in relation to optimal and borderline risk factors: comparison of African American with white subjects--Atherosclerosis Risk in Communities Study. Archives of internal medicine, 2007. 167(6): p. 573-9.
[17]  Benjamin, E.J., et al., Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation, 2019. 139(10): p. e56-e528.
[18]  Go, A.S., et al., Heart disease and stroke statistics--2014 update: a report from the american heart association. Circulation, 2014. 129(3): p. e28-e292.
[19]  Egan, B.M., et al., Hypertension in the United States 1999–2012: Progress Toward Healthy People 2020 Goals. Circulation, 2014. 130(19): p. 1692-9.
[20]  Thorpe, R.J., et al., Economic Burden of Men's Health Disparities in the United States. International Journal of Men's Health, 2013. 12(3).
[21]  Ferdinand, K.C. and A. Armani, Cardiovascular Disease in Racial and Ethnic Minorities. 2010: Humana; Springer Science & Buisness Media.
[22]  Ferdinand, K.C. and A.M. Armani, The management of hypertension in African Americans. Critical pathways in cardiology, 2007. 6(2): p. 67-71.
[23]  Diaz, K.M., et al., Prevalence, Determinants, and Clinical Significance of Masked Hypertension in a Population-Based Sample of African Americans: The Jackson Heart Study. Am J Hypertens, 2015. 28(7): p. 900-8.
[24]  Patel, P.D., J.L. Velazquez, and R.R. Arora, Endothelial dysfunction in African-Americans. Int J Cardiol, 2009. 132(2): p. 157-72.
[25]  Veerabhadrappa, P., et al., Endothelial-dependent flow-mediated dilation in African Americans with masked-hypertension. Am J Hypertens, 2011. 24(10): p. 1102-7.
[26]  Perticone, F., et al., Prognostic significance of endothelial dysfunction in hypertensive patients. Circulation, 2001. 104(2): p. 191-6.
[27]  Cardillo, C. and J.A. Panza, Impaired endothelial regulation of vascular tone in patients with systemic arterial hypertension. Vasc Med, 1998. 3(2): p. 138-44.
[28]  Taddei, S., et al., Defective L-arginine-nitric oxide pathway in offspring of essential hypertensive patients. Circulation, 1996. 94(6): p. 1298-303.
[29]  Campia, U., et al., Reduced endothelium-dependent and -independent dilation of conductance arteries in African Americans. J Am Coll Cardiol, 2002. 40(4): p. 754-60.
[30]  Perregaux, D., et al., Brachial vascular reactivity in blacks. Hypertension, 2000. 36(5): p. 866-71.
[31]  Cook, M.D., Endothelial Cell Function and Hypertension: Interactions Among Inflammation, Immune Function, and Exercise, in Effects of Exercise on Hypertension: From Cells to Physiological Systems, L.S. Pescatello, Editor. 2015, Humana Press: Springer: New York. p. 301-323.
[32]  Babbitt, D.M., et al., Endothelial activation microparticles and inflammation status improve with exercise training in african americans. International journal of hypertension, 2013. 2013: p. 538017.
[33]  Brown, M.D., et al., Racial differences in tumor necrosis factor-alpha-induced endothelial microparticles and interleukin-6 production. Vascular health and risk management, 2011. 7: p. 541-50.
[34]  Diaz, K.M., et al., Visit-to-visit and 24-h blood pressure variability: association with endothelial and smooth muscle function in African Americans. J Hum Hypertens, 2013. 27(11): p. 671-7.
[35]  Feairheller, D.L., et al., Effects of moderate aerobic exercise training on vascular health and blood pressure in African Americans. J Clin Hypertens (Greenwich), 2014. 16(7): p. 504-10.
[36]  Brown, M.D. and D.L. Feairheller, Are there race-dependent endothelial cell responses to exercise? Exerc Sport Sci Rev, 2013. 41(1): p. 44-54.
[37]  Brown, M.D., et al., Racial differences in tumor necrosis factor-alpha-induced endothelial microparticles and interleukin-6 production. Vasc Health Risk Manag, 2011. 7: p. 541-50.
[38]  Feairheller, D.L., et al., Racial differences in oxidative stress and inflammation: in vitro and in vivo. Clin Transl Sci, 2011. 4(1): p. 32-7.
[39]  Lovren, F. and S. Verma, Evolving role of microparticles in the pathophysiology of endothelial dysfunction. Clin Chem, 2013. 59(8): p. 1166-74.
[40]  Spieker, L.E., et al., Working under pressure: the vascular endothelium in arterial hypertension. J Hum Hypertens, 2000. 14(10-11): p. 617-30.
[41]  Ekholm, M., et al., Effects of Angiotensin-Converting Enzyme Inhibition and Alpha 1-Adrenergic Receptor Blockade on Inflammation and Hemostasis in Human Hypertension. J Cardiovasc Pharmacol, 2018. 71(4): p. 240-247.
[42]  Lund, L.H., ACE inhibitors in African Americans with hypertension associated with worse outcomes as compared to other antihypertensives. Evid Based Med, 2016. 21(1): p. 33-4.
[43]  Grimm, H., et al., The Effects of Exercise, Aspirin, and Celecoxib in an Atherogenic Environment. Med Sci Sports Exerc, 2018. 50(10): p. 2033-2039.
[44]  Cheng, Y., et al., Role of prostacyclin in the cardiovascular response to thromboxane A2. Science, 2002. 296(5567): p. 539-41.
[45]  Cipollone, F., G. Cicolini, and M. Bucci, Cyclooxygenase and prostaglandin synthases in atherosclerosis: recent insights and future perspectives. Pharmacol Ther, 2008. 118(2): p. 161-80.
[46]  Collado, M.C., et al., Gut microbiota: a source of novel tools to reduce the risk of human disease? Pediatr Res, 2015. 77(1-2): p. 182-8.
[47]  Sekirov, I., et al., Gut microbiota in health and disease. Physiol Rev, 2010. 90(3): p. 859-904.
[48]  Guo, Z., et al., Influence of consumption of probiotics on the plasma lipid profile: a meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis, 2011. 21(11): p. 844-50.
[49]  Tabuchi, M., et al., Antidiabetic effect of Lactobacillus GG in streptozotocin-induced diabetic rats. Biosci Biotechnol Biochem, 2003. 67(6): p. 1421-4.
[50]  Cole-Jeffrey, C.T., et al., ACE2 and Microbiota: Emerging Targets for Cardiopulmonary Disease Therapy. J Cardiovasc Pharmacol, 2015.
[51]  Khalesi, S., et al., Effect of probiotics on blood pressure: a systematic review and meta-analysis of randomized, controlled trials. Hypertension, 2014. 64(4): p. 897-903.
[52]  Gomez-Guzman, M., et al., Antihypertensive effects of probiotics Lactobacillus strains in spontaneously hypertensive rats. Mol Nutr Food Res, 2015.
[53]  Yang, T., et al., Gut dysbiosis is linked to hypertension. Hypertension, 2015. 65(6): p. 1331-40.
[54]  Yan, Q., et al., Alterations of the Gut Microbiome in Hypertension. Front Cell Infect Microbiol, 2017. 7: p. 381.
[55]  Hester, C.M., et al., Fecal microbes, short chain fatty acids, and colorectal cancer across racial/ethnic groups. World J Gastroenterol, 2015. 21(9): p. 2759-69.
[56]  Ciubotaru, I., et al., Significant differences in fecal microbiota are associated with various stages of glucose tolerance in African American male veterans. Transl Res, 2015. 166(5): p. 401-11.
[57]  Goodrich, J.K., et al., Human genetics shape the gut microbiome. Cell, 2014. 159(4): p. 789-99.
[58]  Ou, J., et al., Diet, microbiota, and microbial metabolites in colon cancer risk in rural Africans and African Americans. Am J Clin Nutr, 2013. 98(1): p. 111-20.
[59]  O'Keefe, S.J., Diet, microorganisms and their metabolites, and colon cancer. Nat Rev Gastroenterol Hepatol, 2016. 13(12): p. 691-706.
[60]  Bailey, M.T., Psychological Stress, Immunity, and the Effects on Indigenous Microflora. Adv Exp Med Biol, 2016. 874: p. 225-46.
[61]  Serino, M., et al., Far from the eyes, close to the heart: dysbiosis of gut microbiota and cardiovascular consequences. Curr Cardiol Rep, 2014. 16(11): p. 540.
[62]  Desai, M.S., et al., A Dietary Fiber-Deprived Gut Microbiota Degrades the Colonic Mucus Barrier and Enhances Pathogen Susceptibility. Cell, 2016. 167(5): p. 1339-1353 e21.
[63]  Santisteban, M.M., et al., Hypertension-Linked Pathophysiological Alterations in the Gut. Circ Res, 2016.
[64]  Li, J., et al., Gut microbiota dysbiosis contributes to the development of hypertension. Microbiome, 2017. 5(1): p. 14.
[65]  Podschun, R. and U. Ullmann, Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev, 1998. 11(4): p. 589-603.
[66]  Ley, R.E., Gut microbiota in 2015: Prevotella in the gut: choose carefully. Nat Rev Gastroenterol Hepatol, 2016. 13(2): p. 69-70.
[67]  Kumar, S., et al., Novel aromatic ester from Piper longum and its analogues inhibit expression of cell adhesion molecules on endothelial cells. Biochemistry, 2005. 44(48): p. 15944-52.
[68]  Chamkha, M., J.L. Garcia, and M. Labat, Metabolism of cinnamic acids by some Clostridiales and emendation of the descriptions of Clostridium aerotolerans, Clostridium celerecrescens and Clostridium xylanolyticum. Int J Syst Evol Microbiol, 2001. 51(Pt 6): p. 2105-11.
[69]  Morrison, D.J. and T. Preston, Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism. Gut Microbes, 2016. 7(3): p. 189-200.
[70]  Pevsner-Fischer, M., et al., The gut microbiome and hypertension. Curr Opin Nephrol Hypertens, 2017. 26(1): p. 1-8.
[71]  Wong, J.M., et al., Colonic health: fermentation and short chain fatty acids. J Clin Gastroenterol, 2006. 40(3): p. 235-43.
[72]  O'Keefe, S.J., et al., Why do African Americans get more colon cancer than Native Africans? J Nutr, 2007. 137(1 Suppl): p. 175S-182S.
[73]  Pluznick, J., A novel SCFA receptor, the microbiota, and blood pressure regulation. Gut Microbes, 2014. 5(2): p. 202-7.
[74]  Zapolska-Downar, D., et al., Butyrate inhibits cytokine-induced VCAM-1 and ICAM-1 expression in cultured endothelial cells: the role of NF-kappaB and PPARalpha. J Nutr Biochem, 2004. 15(4): p. 220-8.
[75]  van der Beek, C.M., et al., Hepatic Uptake of Rectally Administered Butyrate Prevents an Increase in Systemic Butyrate Concentrations in Humans. J Nutr, 2015. 145(9): p. 2019-24.
[76]  Wilck, N., et al., Salt-responsive gut commensal modulates TH17 axis and disease. Nature, 2017. 551(7682): p. 585-589.
[77]  LeBlanc, J.G., et al., Beneficial effects on host energy metabolism of short-chain fatty acids and vitamins produced by commensal and probiotic bacteria. Microb Cell Fact, 2017. 16(1): p. 79.
[78]  Cook, M.D., et al., Exercise and gut immune function: Evidence of alterations in colon immune cell homeostasis and microbiome characteristics with exercise training. Immunol Cell Biol, 2015.
[79]  Allen, J.M., et al., Exercise Alters Gut Microbiota Composition and Function in Lean and Obese Humans. Med Sci Sports Exerc, 2017.
[80]  Mailing, L.J., et al., Exercise and the Gut Microbiome: A Review of the Evidence, Potential Mechanisms, and Implications for Human Health. Exerc Sport Sci Rev, 2019. 47(2): p. 75-85.
[81]  Brown, M.D. and D.L. Feairheller, Are there race-dependent endothelial cell responses to exercise? Exercise and sport sciences reviews, 2013. 41(1): p. 44-54.
[82]  Gleeson, M., et al., The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nature reviews. Immunology, 2011. 11(9): p. 607-15.
[83]  Wilson, I.D. and J.K. Nicholson, Gut microbiome interactions with drug metabolism, efficacy, and toxicity. Transl Res, 2017. 179: p. 204-222.