Uncovering immune pathways for therapeutic targeting of hypertension.

Introduction: Hypertension is a major health problem worldwide, yet fewer than half of patients maintain adequate blood-pressure control, pointing to hidden pathogenic drivers and therapeutic gaps. Normal pressure regulation depends on seamless cross-talk among the kidney, vasculature, brain, and gut; once this dialogue falters, low-grade, T cell-centered inflammation sustains disease.

Areas covered: In the kidney, CD8 ⁺ T cells bearing the purinergic receptor P2X7sense extracellular ATP and hypertonicity, upregulate renal sodium transporters, and lock in salt. Perivascular adipose tissue mobilizes monocytes, γδ T cells, and B cells that, through CCL5-guided trafficking and IFN-γ/IL-17A release, heighten oxidative stress and endothelial dysfunction - defects reversible by regulatory T-cell transfer. In the central nervous system, angiotensin II and dietary salt skew microglia toward a pro-inflammatory state, breach the blood-brain barrier and attract Th17 and γδ T cells, establishing a sympathetic feed-forward loop. Concurrent gut dysbiosis - marked by excess short-chain fatty acids and dwindling aryl-hydrocarbon metabolites - reprograms macrophage and T-cell phenotypes, reinforcing systemic inflammation.

Expert opinion: Targeting these inter-organ immune circuits, especially activation and infiltration of T cells and inflammasome, will provide precise immunomodulatory strategies poised to deliver enduring blood-pressure control and cardiovascular protection.