Tao Li

Background: Prehypertension is more likely to develop into hypertension in individuals with adiposity. We aimed to explore how adiposity influences prehypertension through gut microbiota. Methods: Kaplan–Meier and Cox proportional hazard regression models were employed to evaluate the association between prehypertension and adiposity in 649 individuals. Among them, 197 consented to provide fecal samples and were divided, along with 184 additional participants, into healthy controls (HC), individuals with adiposity and normal tension (Ad-NT), and those with prehypertension (Ad-pHT) based on body mass index (BMI) and blood pressure. Shotgun metagenomic sequencing was performed on fecal samples, followed by taxonomic and functional annotations using MetaPhlAn and HUMAnN. Linear discriminant analysis effect size (LEfSe) was used to analyze differences in microbial species and metabolic pathways across groups. Partial Spearman rank correlation analysis was used to assess microbial interactions, and the relationships among metabolic pathways, species, BMI, and blood pressure. Results: Elevated BMI independently predicted the risk of prehypertension (adjusted HR = 1.072, 95% CI: 1.002–1.147). We observed the depletion of Blautia wexlerae and Parabacteroides distasonis in populations with Ad-pHT. A multiclass logistic regression model distinguished individuals with Ad-pHT from HC and those with adiposity and normal tension (Ad-NT) (AUC = 0.704). Microbiota-microbiota interactions gradually become complex from HC to Ad-NT to Ad-pHT groups. Blautia wexlerae and Parabacteroides distasonis were associated with pathways involved in carbohydrate degradation (PWY-8004), fermentation (ANAEROFRUCAT-PWY), biosynthesis of secondary metabolites (PWY-6270), amino acid (ARGININE-SYN4-PWY), quinol and quinone (PWY-7992), and nucleoside and nucleotide (PWY-6700). Conclusion: Shifts in Blautia wexlerae and Parabacteroides distasonis , as well as their relationships with pathways (energy metabolism and amino acid biosynthesis), were observed in adiposity-related prehypertension. Blautia wexlerae and Parabacteroides distasonis might represent promising candidates for next-generation probiotics targeting weight management and blood pressure reduction, which require validation in clinical studies.