SYSTEMATIC REVIEW article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1685424
This article is part of the Research TopicGut Microbiota and Cardiovascular Endocrinology: Emerging InsightsView all articles
Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Impact on the Gut Microbiome: A Systematic Review
Provisionally accepted
Elisabeth Wang*
Abdulwhab Shremo Msdi
Vy N QuachSelena Q NguyenEmily QuachJinhee JoTaryn A EubankKevin W GareyNatalie Rosario- University of Houston, Houston, United States
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Background: Inhibition of the renin–angiotensin system (RAS) may influence gut microbial composition and blood pressure, yet current evidence remains limited. This review examines how angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) modify gut microbiome composition, function, and blood pressure regulation. Methods: We conducted a systematic search of MEDLINE and EMBASE from inception to September 2025 using terms including “human,” “rat,” “angiotensin converting enzyme inhibitor,” “angiotensin receptor blocker,” and “gut microbiome.” Eligible studies were required to report changes in microbiome diversity, bacterial composition, or short-chain fatty acids (SCFAs) associated with ACEi/ARB treatment across animal or human models. Data extraction and risk of bias assessments were performed independently by multiple reviewers. Results: After deduplication 642 retrieved articles were filtered and nine met inclusion criteria (eight in rodent models, one human study). ACEi/ARB administration in animals was associated with increased microbial diversity, restoration of intestinal oxygen balance, and enrichment of SCFA-producing anaerobic genera such as Bifidobacterium, Bacteroides, Blautia, and Akkermansia. In the human study, ACEi/ARB use did not significantly alter microbial diversity, but decreased populations of facultative aerobic pathogens including Staphylococcus and Enterobacterales. Functionally, prolonged RAS inhibition elevated levels of acetate, propionate, and butyrate, and enhanced gut barrier integrity while attenuating inflammatory signaling. The human study was found to have a moderate risk of bias. Conclusions: ACEi and ARB therapies appear to reshape gut microbiome structure and metabolic function, promoting SCFA-producer expansion, improved gut barrier integrity, and modulation of microbial taxa linked to inflammation and hypertension. However, human data is limited, and further transitional research is needed to confirm these findings.
Keywords: Hypertension, ACEi (Angiotensin conversing enzyme inhibitor), ARBs (angiotensin II receptor blockers), microbiome, Microbiome & dysbiosis
Received: 13 Aug 2025; Accepted: 09 Oct 2025.
Copyright: © 2025 Wang, Shremo Msdi, Quach, Nguyen, Quach, Jo, Eubank, Garey and Rosario. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Elisabeth Wang, emwang@central.uh.edu
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