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A growing body of evidence supports it is key in how the gut microbiome contributes to several diseases, including hypertension and cardiovascular diseases (CVDs). Evidence over the past decade supports a causal link of the gut microbiome in hypertension and its complications, including myocardial infarction, atherosclerosis, heart failure, and stroke. Perturbations in gut homeostasis such as dysbiosis (i.e., alterations in gut microbial composition) may trigger immune responses that lead to chronic low\u2010grade inflammation and, ultimately, the development and progression of these conditions. This is unsurprising, as the gut harbors one of the largest numbers of immune cells in the body, yet is a phenomenon not entirely understood in the context of cardiometabolic disorders. In this review, we discuss the role of the gut microbiome, the immune system, and inflammation in the context of hypertension and CVD, and consolidate current evidence of this complex interplay, whilst highlighting gaps in the literature. We focus on diet as one of the major modulators of the gut microbiota, and explain key microbial\u2010derived metabolites (e.g., short\u2010chain fatty acids, trimethylamine <jats:italic>N<\/jats:italic>\u2010oxide) as potential mediators of the communication between the gut and peripheral organs such as the heart, arteries, kidneys, and the brain via the immune system. Finally, we explore the dual role of both the gut microbiome and the immune system, and how they work together to not only contribute, but also mitigate hypertension and CVD.<\/jats:p>","DOI":"10.1111\/apha.14193","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T11:39:40Z","timestamp":1718883580000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["The gut\u2013immune axis during hypertension and cardiovascular diseases"],"prefix":"10.1111","volume":"240","author":[{"given":"Evany","family":"Dinakis","sequence":"first","affiliation":[{"name":"Hypertension Research Laboratory, School of Biological Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne A.","family":"O'Donnell","sequence":"additional","affiliation":[{"name":"Hypertension Research Laboratory, School of Biological Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4920-9991","authenticated-orcid":false,"given":"Francine Z.","family":"Marques","sequence":"additional","affiliation":[{"name":"Hypertension Research Laboratory, School of Biological Sciences Monash University  Melbourne Victoria Australia"},{"name":"Heart Failure Research Group Baker Heart and Diabetes Institute  Melbourne Victoria Australia"},{"name":"Victorian Heart Institute Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2018.14"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjh.0000226212.34055.86"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2016.12.2.137"},{"key":"e_1_2_11_5_1","volume-title":"Cardiovascular diseases (CVDs)","author":"WHO","year":"2021"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms232112906"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-020-00875-0"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-023-02260-4"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41422-020-0332-7"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-023-00964-1"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.2174\/1568010033484098"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9010241"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-022-00955-7"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-016-0483-x"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2019.03.001"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1155\/2010\/585989"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjhyper.2004.03.675"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.290.22.2945"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.08.069"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/hs1101.098151"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.86.3.7305"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-2143(97)90178-5"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jash.2014.05.007"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.303697"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI74084"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jhh.1001845"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.112.199265"},{"issue":"4","key":"e_1_2_11_28_1","article-title":"Activation of the NF\u2010kappa B and I kappa B system in smooth muscle cells after rat arterial injury. 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