Role of dietary potassium and salt substitution in the prevention and management of hypertension.

Jinho Shin, Kazoumi Kario, Maong-Hui Cheng, Ji-Guang Wang, Markus P Schlaich, Feng J He, Hao-Min Cheng, Yuda Turana, Yook-Chin Chia, Narsingh Verma, Peera Buranakitjaroen, Apichard Sukonthasarn, Tzung-Dau Wang, Jorge Sison, Saulat Siddique, Jam Chin Tay, Minh Van Huynh

Journal: Hypertension research : official journal of the Japanese Society of Hypertension 2025;48(1):301-313

PMID: 39472546

Full Text on Nature Publishing Group View on PubMed

Abstract

Cardiovascular diseases (CVD) continue to be the leading cause of deaths and disability worldwide and the major contributor is hypertension. Despite all the improvements in detecting hypertension together with technological advances and affordable, efficacious and relatively free of adverse effects anti-hypertensive agents, we continue to struggle to prevent the onset of hypertension and to control blood pressure (BP) to acceptable targets. The poor control of hypertension is commonly due to non-adherence to medications. Another reason is the failure to adopt diet and lifestyle changes. Reduction of dietary salt intake is important for lowering BP but the role of potassium intake is also important. Globally the intake of sodium is double that of the recommended 2 gm per day (equivalent to 5 gm of sodium chloride/salt) and half that of the daily recommended intake of potassium of 3500 mg/day, giving a sodium-to-potassium ratio of >1, when ideally it should be <1. Many studies have shown that a higher potassium intake is associated with lower BPs, particularly when coupled concurrently with a lower sodium intake giving a lower sodium to potassium ratio. Most hypertension guidelines, while recommending reduction of salt intake to a set target, do not specifically recommend a target for potassium intake nor potassium supplementation. Here we review the role of potassium and salt substitution with potassium in the management of hypertension. Hence, the focus of dietary changes to lower BP and improve BP control should not be on reduction of salt intake alone but more importantly should include an increase in potassium intake.

Address: Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia. [email protected].; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. [email protected].; Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK.; Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia.; Faculty of Cardiology Service, Hanyang University Medical Center, Seoul, South Korea.; Ph.D. Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.; Division of Faculty Development, Taipei Veterans General Hospital, Taipei City, Taiwan.; Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.; Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.; Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.; Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.; Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam.; Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.; Section of Cardiology, Department of Medicine, Medical Center Manila, Manila, Philippines.; Punjab Medical Center, Lahore, Pakistan.; Department of Neurology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.; Department of Physiology, King George's Medical University, Lucknow, India.; Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore.; Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and Royal Perth Hospital Research Foundation, The University of Western Australia, Perth, WA, Australia.; Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, the Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.

DOI: 10.1038/s41440-024-01862-w

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MeSH Terms: Humans, Hypertension, Potassium, Dietary, Sodium Chloride, Dietary, Blood Pressure