What is it about?
High blood pressure is a very common condition and a major cause of heart and blood vessel disease. One of the most frequently prescribed treatments is hydrochlorothiazide, a diuretic antihypertensive drug that helps the body eliminate excess salt and water. However, in many cases its effect is not enough to fully control blood pressure. In this study, we investigated whether a specific probiotic, Limosilactobacillus fermentum CECT5716, could improve the blood pressure–lowering effect of hydrochlorothiazide. Using an established animal model of hypertension, we found that when the probiotic was given together with the drug, blood pressure was reduced more effectively than with the drug alone. This combined treatment was also linked to healthier blood vessels, lower inflammation, and beneficial changes in gut bacteria. These results suggest that the gut microbiota may play an important role in how well antihypertensive drugs work. In the future, combining standard medications with selected probiotics could become a complementary strategy to improve blood pressure control, although further studies in humans are needed to confirm this approach.
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Why is it important?
This work is unique because it shows that the effectiveness of a widely used antihypertensive drug, hydrochlorothiazide, can be enhanced by targeting the gut microbiota. While probiotics are often studied as stand-alone interventions, our study is among the first to demonstrate that a specific probiotic can act as a complementary strategy to improve the response to a standard blood pressure–lowering medication. The timing of this research is especially relevant. Many patients with hypertension do not achieve adequate blood pressure control with current drug treatments alone, and there is growing interest in non-pharmacological approaches that can support conventional therapies. By linking gut microbiota modulation to improved drug efficacy, this study opens a new perspective on personalized and integrative management of hypertension. If confirmed in humans, these findings could make a practical difference by helping clinicians optimize existing treatments rather than relying solely on higher doses or additional drugs. More broadly, the study supports the idea that combining medicines with targeted microbiota-based interventions may represent a new way to improve outcomes in chronic cardiovascular diseases.
Perspectives
Working on this study was particularly meaningful for me because it builds directly on a broader research line in which we have been exploring how the gut microbiota interacts with antihypertensive therapies. In previous work, we showed that classic cardiovascular drugs such as spironolactone can improve gut dysbiosis and reduce sympathetic drive in hypertension, linking microbiota changes to vascular and immune improvements (doi:10.1016/j.biopha.2022.114149). More recently, we demonstrated that different first-line antihypertensive drugs interact with the gut microbiota in very distinct ways, and that, unlike other agents, hydrochlorothiazide does not rely on microbiota changes to lower blood pressure (doi:10.1111/bph.16410). Against this background, the present article represents a natural next step. Rather than focusing only on how drugs modify the microbiota, we asked whether selectively targeting the gut ecosystem with a probiotic could enhance the effectiveness of a widely used antihypertensive diuretic. From my perspective, this shift in approach is important, as it moves from describing associations to testing practical strategies that could complement existing treatments. Overall, I see this publication as part of a coherent effort to better understand variability in antihypertensive drug response and to explore integrative solutions that combine pharmacology and microbiota-based interventions. I hope that, taken together, these studies encourage a more nuanced view of hypertension treatment, where gut–drug interactions are considered an opportunity rather than a complication.
Dr Manuel Gómez-Guzmán
University of Granada
Read the Original
This page is a summary of: The probiotic
Limosilactobacillus fermentum
CECT5716 enhances the antihypertensive response to hydrochlorothiazide in spontaneously hypertensive rats, Gut Microbes, November 2025, Taylor & Francis,
DOI: 10.1080/19490976.2025.2586324.
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