Potassium and hypertension
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- David B Mount, MD
David B Mount, MD
- Assistant Professor of Medicine
- Harvard Medical School
A low dietary intake of potassium may increase the blood pressure, and potassium supplementation almost always lowers elevated blood pressure. The data demonstrating these associations, as well as the potential mechanisms, will be reviewed here. The approach to patients who present with concurrent hypertension and hypokalemia, and the clinical features of primary aldosteronism are discussed separately. (See "Diagnosis of primary aldosteronism" and "Pathophysiology and clinical features of primary aldosteronism".)
POTASSIUM INTAKE AND BLOOD PRESSURE
The level of potassium intake can affect blood pressure. The effect varies with the direction (low potassium intake raises the blood pressure and high potassium intake lowers the blood pressure) and magnitude of change in potassium intake.
Low-potassium diet — Low dietary potassium intake (below 40 meq/day [1.5 g/day]) has been associated with an elevation in blood pressure and an increased risk of stroke [1-4], as well as an increase in risk of chronic kidney disease . The following observations are illustrative:
●In two different studies, one in healthy normotensive men  and one in patients with primary hypertension (formerly called essential hypertension) , potassium restriction from a normal intake of 80 to 90 meq/day down to 10 to 18 meq/day led to a statistically significant 4 to 5 mmHg increase in systolic blood pressure. The increase in blood pressure may have been mediated in part by sodium retention.
●In a meta-analysis of 11 cohort studies and nearly 250,000 individuals, a 1.64 g (42 mmol)/day higher potassium intake was associated with a 21 percent lower risk of stroke .
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: May 17, 2016.References
- Aburto NJ, Hanson S, Gutierrez H, et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013; 346:f1378.
- D'Elia L, Barba G, Cappuccio FP, Strazzullo P. Potassium intake, stroke, and cardiovascular disease a meta-analysis of prospective studies. J Am Coll Cardiol 2011; 57:1210.
- O'Donnell MJ, Yusuf S, Mente A, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA 2011; 306:2229.
- Green DM, Ropper AH, Kronmal RA, et al. Serum potassium level and dietary potassium intake as risk factors for stroke. Neurology 2002; 59:314.
- Araki S, Haneda M, Koya D, et al. Urinary Potassium Excretion and Renal and Cardiovascular Complications in Patients with Type 2 Diabetes and Normal Renal Function. Clin J Am Soc Nephrol 2015; 10:2152.
- Krishna GG, Miller E, Kapoor S. Increased blood pressure during potassium depletion in normotensive men. N Engl J Med 1989; 320:1177.
- Coruzzi P, Brambilla L, Brambilla V, et al. Potassium depletion and salt sensitivity in essential hypertension. J Clin Endocrinol Metab 2001; 86:2857.
- Hedayati SS, Minhajuddin AT, Ijaz A, et al. Association of urinary sodium/potassium ratio with blood pressure: sex and racial differences. Clin J Am Soc Nephrol 2012; 7:315.
- Yang Q, Liu T, Kuklina EV, et al. Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey. Arch Intern Med 2011; 171:1183.
- Castro H, Raij L. Potassium in hypertension and cardiovascular disease. Semin Nephrol 2013; 33:277.
- Binia A, Jaeger J, Hu Y, et al. Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J Hypertens 2015; 33:1509.
- 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.
- Aviv A, Hollenberg NK, Weder A. Urinary potassium excretion and sodium sensitivity in blacks. Hypertension 2004; 43:707.
- Turban S, Miller ER 3rd, Ange B, Appel LJ. Racial differences in urinary potassium excretion. J Am Soc Nephrol 2008; 19:1396.
- Frisancho AR, Leonard WR, Bollettino LA. Blood pressure in blacks and whites and its relationship to dietary sodium and potassium intake. J Chronic Dis 1984; 37:515.
- Adrogué HJ, Madias NE. Sodium and potassium in the pathogenesis of hypertension. N Engl J Med 2007; 356:1966.
- Appel LJ, Giles TD, Black HR, et al. ASH position paper: dietary approaches to lower blood pressure. J Am Soc Hypertens 2010; 4:79.
- Terker AS, Zhang C, McCormick JA, et al. Potassium modulates electrolyte balance and blood pressure through effects on distal cell voltage and chloride. Cell Metab 2015; 21:39.
- Gallen IW, Rosa RM, Esparaz DY, et al. On the mechanism of the effects of potassium restriction on blood pressure and renal sodium retention. Am J Kidney Dis 1998; 31:19.
- He FJ, Markandu ND, Coltart R, et al. Effect of short-term supplementation of potassium chloride and potassium citrate on blood pressure in hypertensives. Hypertension 2005; 45:571.
- He FJ, Marciniak M, Carney C, et al. Effects of potassium chloride and potassium bicarbonate on endothelial function, cardiovascular risk factors, and bone turnover in mild hypertensives. Hypertension 2010; 55:681.