HTN: Potassium 2008
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
Dietitians should advise individuals to consume adequate food sources of potassium as part of Medical Nutrition Therapy to reduce blood pressure. Research suggests that potassium intake lower than recommended levels (DRI) is associated with increased blood pressure.
Risks/Harms of Implementing This Recommendation
Potassium from food, supplements or salt substitutes can result in hyperkalemia and possibly sudden death if excess is consumed by individuals with impaired kidney function and/or taking ACE inhibitors, renin inhibitors, angiotensin receptor blockers (ARBs), potassium-sparing diuretics or aldosterone antagonists.
Conditions of Application
No conditions specified.
Potential Costs Associated with Application
- Five studies with potassium intakes below recommended levels report an association with increased blood pressure (Cheung et al, 2000; Geleijnse et al, 2003; Hajjar and Kotchen, 2003; Geleijnse et al, 2004; Zhao et al, 2004).
- Based on three randomized controlled trials and two meta-analyses, an increase in potassium intake of 200 to 2, 000 mg per day (5 to 50 mmol per day) results in a significant reduction in systolic blood pressure of approximately 2-8 mmHg and in diastolic blood pressure of approximately 2-6 mmHg (Espeland et al, 2002; Geleijnse et al, 2003; Naismith et al, 2003; Geleijnse et al, 2004, Wu et al, 2006).
- Seven studies report no association between potassium intake and blood pressure; however, five of these studies report a positive association between the sodium-potassium ratio and blood pressure (Silaste et al, 2000; Hu and Tian, 2001; Liu et al, 2001, Schroder et al, 2002; Kwok et al, 2003; Khaw et al, 2004; Lancaster et al, 2004).
Recommendation Strength Rationale
- Conclusion Statement is Grade II
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the relationship between potassium intake and blood pressure in healthy and hypertensive adults?
Cheung BMY, Ho SPC, Cheung AHK, Lau CP. Diastolic blood pressure is related to urinary sodium excretion in hypertensive Chinese patients. Q J Med. 2000; 93: 163-168.
Espeland MA, Kumanyika S, Yunis C, Zheng B, Brown WM, Jackson S, Wilson AC, Bahnson J, Electrolyte intake and nonpharmacologic blood pressure control. Ann Epidemiol. 2002; 12: 587-595.
Geleijnse JM, Kok FJ, Grobbee DE. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials. Journal of Human Hypertension, 2003; 17: 471-480.
Geleijnse JM, Kok FJ, Grobbee DE. Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. Eur J Public Health. 2004; 14 (3): 235-239.
Hajjar I, Kotchen T. Regional variations of blood pressure in the United States are associated with regional variations in dietary intakes: The NHANES III Data. J Nutr. 2003; 133: 211-214.
Hu G, Tian H. A comparison of dietary and non-dietary factors of hypertension and normal blood pressure in a Chinese population. Journal of Human Hypertension, 2001; 15: 487-493.
Khaw KT, Bingham S, Welch A, Luben R, O'Brien E, Wareham N, Day N. Blood pressure and urinary sodium in men and women: the Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). Am J Clin Nutr. 2004; 80: 1,397-1,403.
Kwok TCY, Chan TYK, Woo J. Relationship of urinary sodium/potassium excretion and calcium intake to blood pressure and prevalence of hypertension among older Chinese vegetarians. European Journal of Clinical Nutrition, 2003; 57: 299-304.
Lancaster KJ, Smiciklas-Wright H, Weltzel LB, Mitchell DC, Friedman JM, Jensen GL. Hypertension-related dietary patterns of rural older adults. Preventive Medicine, 2004; 38: 812-818.
Liu L, Liu L, Ding Y, Huang Z, He B, Sun S, Zhao G, Zhang H, Miki T, Mizushima S, Ikeda K, Nara Y, Yamori Y. Ethnic and environmental differences in various markers of dietary intake and blood pressure among Chinese Han and three other minority peoples of China: results from the WHO Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. Hypertens Res. 2001; 24 (3): 315-322.
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.
Schroder H, Schmelz E, Marrugat J. Relationship between diet and blood pressure in a representative Mediterranean population. Eur J Nutr. 2002; 41 (4): 161-167.
Silaste M-L, Junes R, Rantala AO, Kauma H, Lilja M, Savolainen MJ, Reunanen A, Kesaniemi YA. Dietary and other non-pharmacological treatments in patients with drug-treated hypertension and control subjects. Journal of Internal Medicine. 2000; 247: 318-324.
Wu G, Tian H, Han K, Xi Y, Yao Y, Ma A. Potassium magnesium supplementation for four weeks improves small distal artery compliance and reduces blood pressure in patients with essential hypertension. Clin Exp Hypertens. 2006; 28 (5): 489-497.
Zhao L, Stamler J, Yan LL, Zhou B, Wu Y, Liu K, Daviglus ML, Dennis BH, Elliott P, Ueshima H, Yang J, Zhu L, Guo D, for the INTERMAP Research Group. Blood pressure differences between northern and southern Chinese: role of dietary factors. The international study on macronutrients and blood pressure. Hypertension, 2004; 43 (6): 1,332-1,337.
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
The Dietary Reference Intakes (DRI) and Recommended Dietary Allowances (RDA) are issued by the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences.