The Importance of Potassium in Managing Hypertension Authors
First Online: 15 March 2011 DOI:
10.1007/s11906-011-0197-8 Cite this article as: Houston, M.C. Curr Hypertens Rep (2011) 13: 309. doi:10.1007/s11906-011-0197-8 Abstract
Dietary potassium intake has been demonstrated to significantly lower blood pressure (BP) in a dose-responsive manner in both hypertensive and nonhypertensive patients in observational studies, clinical trials, and several meta-analyses. In hypertensive patients, the linear dose–response relationship is a 1.0 mm Hg reduction in systolic BP and a 0.52 mm Hg reduction in diastolic BP per 0.6 g per day increase in dietary potassium intake that is independent of baseline potassium deficiency. The average reduction in BP with 4.7 g (120 mmol) of dietary potassium per day is 8.0/4.1 mm Hg, depending race and on the relative intakes of other minerals such as sodium, magnesium, and calcium. If the dietary sodium chloride intake is high, there is a greater BP reduction with an increased intake of dietary potassium. Blacks have a greater decrease in BP than Caucasians with an equal potassium intake. Potassium-induced reduction in BP significantly lowers the incidence of stroke (cerebrovascular accident, CVA), coronary heart disease, myocardial infarction, and other cardiovascular events. However, potassium also reduces the risk of CVA independent of BP reductions. Increasing consumption of potassium to 4.7 g per day predicts lower event rates for future cardiovascular disease, with estimated decreases of 8% to 15% in CVA and 6% to 11% in myocardial infarction.
Keywords Arterial hypertension Potassium Sodium Potassium/sodium ratio Stroke Coronary heart disease Renal disease Cardiovascular disease Congestive heart failure Dietary control of hypertension Minerals and hypertension Clinical trials of potassium and hypertension Meta-analysis of potassium and hypertension Nutritional medicine Lifestyle modifications References Papers of particular interest, published recently, have been highlighted as: • Of importance
Israili ZH, Hernandez-Hernandez R, Valasco M. The future of antihypertensive treatment. Am J Ther. 2007;14:121–34.
Hajjar I, Kotchne TA. Trends in prevalence, awareness, treatment and control of hypertension in the United States, 1988–2000. The National Health and Nutrition Examination Survey (NHANES), 1999–2000. JAMA. 2003;16:407–143.
Svetkey LP, Simons-Morton DG, Proschan MA, et al. Effect of the dietary approaches to stop hypertension diet and reduced sodium intake on blood pressure control. J Clin Hypertens. 2004;6:373–81.
Cushman WC, Basile J. Achieving blood pressure goals: why aren’t we? J Clin Hyperten. 2006;8:865–72.
Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health. 2006;27:465–90.
Carter BL. Implementing the new guidelines for hypertension: JNC7, ADA, WHO-ISH. J Manag Care Pharm. 2004;10(5 Suppl A):S18–25.
Young DB, Lin H, McCabe RD. Potassium’s cardiovascular protective mechanisms. Am J Physiol. 1995;268(4 Pt 2):R825–37.
INTERSALT Cooperative Research Group. INTERSALT: an international study of electrolyte excretion and blood pressure. Results for 24 h urinary sodium and potassium excretion. Br Med J. 1988;297:319–28.
Cassel J. Studies of hypertension in migrants. In: Paul O, editor. Epidemiology and control of hypertension. Miami: Symposium Specialists; 1975. p. 41–58.
Elfor J, Phillips A, Thomson AG, Shaper AG. Migration and geographic variations in blood pressure in Britain. Br Med J. 1990;300:291–4.
Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH collaborative research group. N Engl J Med. 1997;336:1117–24.
Svetkey LP, Simons-Morton D, Vollmer WM, et al. Effects of dietary patterns on blood pressure - subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Arch Intern Med. 1999;159:285–93.
Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, et al. For the DASH-sodium collaborative research group. Effects on blood pressure or reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001;344:3–10.
Sacks FM, Campos H. Dietary therapy in hypertension. N Engl J Med. 2010;362:2102–12.
• Houston MC. Nutrition and nutraceutical supplements in the treatment of hypertension. Expert Rev Cardiovasc Ther. 2010;8(6):821–833.
This is a comprehensive review of nonpharmacologic treatment of hypertension, with in-depth discussion of the role of nutrition, nutritional supplements, antioxidants, and minerals in preventing and treating hypertension
• Appel, LJ. ASH position paper: dietary approaches to lower blood pressure. J Am Soc Hypertens 2010;4 (2):79–89.
This excellent and recent review of dietary control of hypertension discusses potassium as well as other minerals and foods that reduce BP and CVD. There are many excellent and up-to-date references
Appel LJ, Brands MW, Daniels SR, et al. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006;47:296–308.
Guidelines Committee. European society of hypertension - european society of cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21:1011–63.
Whitworth JA, World Health Organization, International Society of Hypertension Writing Group. World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21(11):1983–92.
Williams B, Poulter NR, Brown MJ, et al. British hypertension society guidelines for hypertension management, 2004 (BHS-IV): Summary. BMJ. 2004;328:634–40.
Reddy KS, Katan MB. Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Pub Health Nutr. 2004;7(1A):167–86.
Adrogue HJ, Madias NE. Sodium and potassium in the pathogenesis of hypertension. N Engl J Med. 2007;356:1966–78.
Geleijnse JM, Kok FJ, Grobbee DE. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials. J Hum Hypertens. 2003;17:471–80.
Roger VL, Go AS, Lloyd-Jones DM, on behalf of the American Heart Association Heart Disease and Stroke Statistics Writing Group, et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18–e209.
Kesteloot H, Joossens JV. Relationship of dietary sodium, potassium, calcium, and magnesium with blood pressure. Belgian interuniversity research on nutrition and health. Hypertension. 1988;12(6):594–9.
Kesteloot H, Park BC, Lee CS, Brems-Heynes E, Claessens J, Joossens JV. A comparative study of blood pressure and sodium intake in Belgium and Korea. Eur J Cardiol. 1980;11:169–82.
Khaw KT, Barrett-Connor E. Dietary potassium and stroke associated mortality. N Engl J Med. 1987;316:235–40.
Kihara M, Fujikawa J, Ohtaka M, et al. Interrelationships between blood pressure, sodium, potassium, serum cholesterol, and protein intake in Japanese. Hypertension. 1984;6:736–42.
Lai S, Yuanchuing H, Weiling H, Peisheng M, Guanquing H. Urinary electrolytes and blood pressure in three Yi farmer populations, China. Hypertension. 1989;13:22–30.
Lever AF, Beretta-Piccoli C, Brown JJ, Davies DL, Fraser R, Robertson JIS. Sodium and potassium in essential hypertension. Br Med J. 1981;283:463–8.
Reed D, McGee D, Yano K, Hankin J. Diet, blood pressure, and multicollinearity. Hypertension. 1985;7(3 Pt 1):405–10.
Sasaki N. High blood pressure and salt intake of the Japanese. Jpn Heart J. 1962;3:313–24.
Walker WG, Whelton PK, Saito H, Russell RP, Hermann J. Relation between blood pressure and renin, renin substrate, angiotensin II, aldosterone and urinary sodium and potassium in 574 ambulatory subjects. Hypertension. 1979;1:287–91.
Yamori Y, Kihara M, Nara Y, et al. Hypertension and diet: multiple regression analysis in a Japanese farming community [letter]. Lancet. 1981;1(8231):1204–5.
Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation. 1998;98:1198–204.
Ascherio A, Rimm EB, Giovannucci EL, Colditz GA, Rosner B, Willett WC, et al. A prospective study of nutritional factors and hypertension among US men. Circulation. 1992;86(5):1475–84.
Kromhout D, Bosschieter EB, Coulander CD. Potassium, calcium, alcohol intake and blood pressure: the Zutphen Study. Am J Clin Nutr. 1985;41(6):1299–304.
McCarron DA, Morris CD, Henry HJ, Stanton JL. Blood pressure and nutrient intake in the United States. Science. 1984;224(4656):1392–8.
Tunstall-Pedoe H. Does dietary potassium lower blood pressure and protect against coronary heart disease and death. Findings from the Scottish Heart Health Study. Semin Nephrol. 1999;19(5):500–2.
Van Leer EM, Seidell JC, Kromhout D. Dietary calcium, potassium, magnesium and blood pressure in the Netherlands. Int J Epidemiol. 1995;24(6):1117–23.
He J, Tell GS, Tang YC, Mo PS, He GQ. Relation of electrolytes to blood pressure in men. The Yi people study. Hypertension. 1991;17(3):378–85.
Cappuccio FP, MacGregor GA. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens. 1991;9(5):465–73.
Whelton PK, He J, Cutler JA, et al. Effects of oral potassium on blood pressure: meta-analysis of randomized controlled clinical trials. JAMA. 1997;277:1624–32.
Dickinson HO, Nicolson DJ, Campbell F, et al. Potassium supplementation for the management of primary hypertension in adults. Cochrane Database Syst Rev. 2006;3:CD004641.
Khaw KT, Rose G. Population study of blood pressure and associated factors in St Lucia, West Indies. Int J Epidemiol. 1982;11(4):372–7.
Mancilha-Carvalho JJ, de Silva NAS. The Yanomami Indians in the INTERSALT study. 2003. Arq Bras Cardio. 2003;80(3):295–300.
Ascherio A, Stampfer MJ, Colditz GA, Willett WC, McKinlay J. Nutrient intakes and blood pressure in normotensive males. Int J Epidemiol. 1991;20(4):886–91.
Ascherio A, Hennekens C, Willett WC, Sacks F, Rosner B, Manson J, et al. Prospective study of nutritional factors, blood pressure, and hypertension among US women. Hypertension. 1996;27(5):1065–72.
Kok FJ, Vandenbroucke JP, van der Heide-Wessel C, van der Heide RM. Dietary sodium, calcium, and potassium, and blood pressure. Am J Epidemiol. 1986;123(6):1043–8.
Witteman JC, Willett WC, Stampfer MJ, Colditz GA, Sacks FM, Speizer FE, et al. A prospective study of nutritional factors and hypertension among US women. Circulation. 1989;80(5):1320–7.
Dyer AR, Elliott P, Shipley M. Urinary electrolyte excretion in 24 h and blood pressure in the INTERSALT Study. II. Estimates of electrolyte-blood pressure associations corrected for regression dilution bias. The INTERSALT Cooperative Research Group. Am J Epidemiol. 1994;139(9):940–51.
Ard JD, Coffman CJ, Lin PH, Svetkey LP. One-year follow-up study of blood pressure and dietary patterns in dietary approaches to stop hypertension (DASH)-sodium participants. Am J Hypertens. 2004;17:1156–62.
Al-Solaiman Y, Jesri A, Mountford WK, Lackland DT, Zhao Y, Egan BM. DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre. J Hum Hypertens. 2010;24(4):237–46.
Lopes HF, Martin KL, Nashar K, Morrow JD, Goodfriend TL, Egan BM. DASH diet lowers blood pressure and lipid-induced oxidative stress in obesity. Hypertension. 2003;41:422–30.
Iimura O, Kijima T, Kikuchi K, Miyama A, Ando T, Nakao T, et al. Studies on the hypotensive effect of high potassium intake in patients with essential hypertension. Clin Sci Lond. 1981;61 Suppl 7:77s–80s.
Grimm Jr RH, Neaton JD, Elmer PJ, et al. The influence of oral potassium chloride on blood pressure in hypertensive men. N Engl J Med. 1990;322:569–74.
The Trials of Hypertension Prevention Collaborative Research Group. The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. JAMA. 1992;267:1213–20.
Gu D, He J, Wu X, et al. Effect of potassium supplementation on blood pressure in Chinese: a randomized, placebo-controlled trial. J Hypertens. 2001;19:1325–31.
Kawano Y, Minami J, Takishita S, Omae T. Effects of potassium supplementation on office, home, and 24-h blood pressure in patients with essential hypertension. Am J Hypertens. 1998;11(10):1141–6.
Braschi A, Naismith DJ, Braschi A. The effect of low-dose potassium supplementation on blood pressure in apparently healthy volunteers. Br J Nutr. 2003;90(1):53–60.
Tobian L. High-potassium diets markedly protect against stroke deaths and kidney disease in hypertensive rats: an echo from prehistoric days. J Hypertens. 1986;4 suppl 4:S67–76.
He FJ, MacGregor GA. Fortnightly review: beneficial effects of potassium. BMJ. 2001;323(7311):497–501.
Iso H, Stampfer MJ, Manson JE, Rexrode K, Hennekens CH, Colditz GA, et al. Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke. 1999;30(9):1772–9.
Compton SJ, Lux RI, Ramsey MR, et al. Genetically defined therapy of inherited long-QT syndrome. Correction of abnormal repolarization by potassium. Circulation. 1996;94:1018–22.
Cohen JD, Neaton JD, Prineas RJ, Daniels KA. Diuretics, serum potassium and ventricular arrhythmias in the multiple risk factor intervention trial. Am J Cardiol. 1987;60(7):548–54.
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265(4):3255–64.
Fujiwara N, Osanai T, Kamada T, Katoh T, Takahashi K, Okumura K. Study on the relationship between plasma nitrite and nitrate level and salt sensitivity in human hypertension: modulation of nitric oxide synthesis by salt intake. Circulation. 2000;101(8):856–61.
Haddy FJ, Vanhoutte PM, Feletou M. Role of potassium in regulating blood flow and blood pressure. Am J Physiol Regul Integr Comp Physiol. 2006;290(3):R546–52.
Amberg GC, Bonev AD, Rossow CF, Nelson MT, Santana LF. Modulation of the molecular composition of large conductance, Ca(2+) activated K(+) channels in vascular smooth muscle during hypertension. J Clin Invest. 2003;112(5):717–24.
Undurti DN. Nutritional factors in the pathobiology of human essential hypertension. Nutrition. 2001;17:337–46.
Pruess HG. Diet, genetics and hypertension. J Am Coll Nutr. 1997;16:296–305.
Barri YM, Wingo CS. The effects of potassium depletion and supplementation on blood pressure: a clinical review. Am J Med Sci. 1997;3:37–40.
Ma G, Mamaril JLC, Young DB. Increased potassium concentration inhibits stimulation of vascular smooth muscle proliferation by PDGF-BB and bFGF. Am J Hypertens. 2000;13:1055–60.
Ando K, Matsui H, Fujita M, Fujita T. Protective effect of dietary potassium against cardiovascular damage in salt-sensitive hypertension: possible role of its antioxidant actions. Curr Vasc Pharmacol. 2010;8(1):59–63.
Kido M, Katsuyuki A, Onozato ML, Tojo A, Yoshikawa M, Ogita T, et al. Protective effect of dietary potassium against vascular injury in salt-sensitive hypertension. Hypertension. 2008;51:225–31.
Ying WZ, Aaron K, Want PX, Sanders PW. Potassium inhibits dietary salt-induced transforming growth factor-beta production. Hypertension. 2009;54(5):1159–63.
Institute of Medicine, Food and Nutrition Board, National Academies of Science. Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate. Available at:
. Accessed February 17, 2011.
• Cook NR, Obarzanek E, Cutler JA, Buring JE, Rexrode KM, Kumanyika SK, Appel LJ, Whelton PK. Trials of Hypertension Prevention Collaborative Research Group. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch Intern Med. 2009;169: 32–40.
This study gives an excellent perspective on the importance of the ratio of sodium and potassium in the diet and their relationship to BP reduction and subsequent decrease in cardiovascular events.
Umesawa M, Iso H, Date C, Yamamoto A, Toyoshima H, Watanabe Y, et al. Relations between dietary sodium and potassium intakes and mortality from cardiovascular disease: the Japan Collaborative Cohort Study for Evaluation of Cancer Risks. Am J Clin Nutr. 2008;88(1):195–202.
Siani A, Strazzullo P, Giacco A, Pacioni D, Celantano E, Mancini M. Increasing the dietary potassium intake reduces the need for antihypertensive medication. Ann Intern Med. 1991;115:753–9.
Gilleran G, O’Leary M, Bartlett WA, Vinall H, Jones AF, Dodson PM. Effects of dietary sodium substitution with potassium and magnesium in hypertensive type II diabetics: a randomized blind controlled parallel study. J Hum Hypertens. 1996;10:517–21.
• Van Mierlo LAJ, Greyling A, Zock PL, Kok FJ, Geleijnse JM. Suboptimal potassium intake and potential impact on population blood pressure. Arch Intern Med. 2010;170(16): 1501–1502.
This is a very good and concise review of the impact of increasing dietary potassium intake on blood pressure and reductions in CVA, CHD, and CVD in populations.
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