Effect of Various Lactobacillus Probiotic Strains on Oral Antihypertensive Drug Response: A Systematic Review

Authors

Khoirunnisa Ramadhani, Undergraduate Pharmacy Student, Universitas Padjadjaran, Sumedang Regency, Jatinangor, IndonesiaFollow
Keri Lestari, Department of Pharmacology and Clinical Pharmacy, Universitas Padjadjaran, Sumedang Regency, Jatinangor, Indonesia

Abstract

Hypertension is a major risk factor for cardiovascular disease, and the effectiveness of antihypertensive therapy can be influenced by metabolic and systemic inflammatory factors associated with gut microbiota conditions. Probiotic strains from the genus Lactobacillus have been reported to modulate antihypertensive effects through complex biological mechanisms. This article evaluates experimental evidence from seven in vivo studies on the influence of Lactobacillus strains on the response to antihypertensive drugs, including pharmacodynamic mechanisms and drug–probiotic interactions. The combination of Lactiplantibacillus plantarum with amlodipine enhanced nitric oxide production, increased eNOS expression, reduced IL-6 levels, and improved drug bioavailability, leading to greater blood pressure reduction. Lactobacillus fermentum administered with losartan synergistically modulated gut microbiota and increased short-chain fatty acid (SCFA) production, improving endothelial and cardiac function. Irbesartan also restored dysbiosis by increasing Lactobacillus abundance and reducing blood pressure through microbiota modulation. Captopril combined with L. fermentum or L. rhamnosus decreased inflammatory cytokines (IL-1β, TNF-α), increased SCFA levels, and improved vascular structure and endothelial function. Conversely, L. rhamnosus co-administration with verapamil induced CYP3A enzyme activity, accelerating verapamil metabolism and reducing systemic availability. These findings indicate that specific Lactobacillus strains can enhance or modify the effects of antihypertensive drugs through mechanisms involving vascular regulation, inflammation control, microbiota restoration, and metabolic enzyme modulation. The evidence supports Lactobacillus-based probiotics as promising adjuvant agents for optimizing antihypertensive therapy and improving cardiovascular outcomes.

Recommended Citation

Ramadhani, Khoirunnisa and Lestari, Keri (2025) "Effect of Various Lactobacillus Probiotic Strains on Oral Antihypertensive Drug Response: A Systematic Review," Pharmacology and Clinical Pharmacy Research: Vol. 10: Iss. 3, Article 8.
Available at: https://journal.unpad.ac.id/pcpr/vol10/iss3/8