Association of the gut microbe-dependent trimethylamine N-oxide and its precursors with risk of hypertension: a cross-sectional study in rural northeastern China

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BACKGROUND AND AIM: This study investigated the relationship between trimethylamine N-oxide (TMAO), its precursors (choline, betaine, and carnitine), and the prevalence of hypertension in rural northeastern China. METHODS AND RESULTS: Conducted in 2019, the cross-sectional study involved 1,899 adults aged 35 and older, with serum levels of TMAO and its precursors quantified using high-performance liquid chromatography-mass spectrometry. Hypertension was defined according to blood pressure measurements or the use of antihypertensive medications, based on the 2018 Chinese Hypertension Guidelines. Logistic regression models were utilized to assess the associations between TMAO, its precursors, and hypertension, adjusting for potential confounders such as age, sex, smoking status, and physical activity. The results revealed a significant association between TMAO concentrations and the prevalence of hypertension. Participants in the highest quartile of TMAO (>7.75 μmol/L) exhibited a 36 % increased risk of hypertension (OR = 1.360, 95 % CI: 1.043-1.772, P = 0.023). Choline also showed a positive association with hypertension (OR = 1.426, 95 % CI: 1.092-1.863, P = 0.009), while no significant association was found for betaine. Conversely, carnitine was negatively associated with hypertension risk in the highest quartile. Subgroup analyses indicated that these associations varied by age, gender, and education level. CONCLUSIONS: Elevated serum levels of TMAO and choline were associated with an increased risk of hypertension. Modulating TMAO metabolism could aid in the prevention of hypertension in the future.

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