Potassium Intake and Blood Pressure: A Dose‐Response Meta‐Analysis of Randomized Controlled Trials
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Open Access
- 16 June 2020
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Heart Association
- Vol. 9 (12), e015719
- https://doi.org/10.1161/jaha.119.015719
Abstract
Background Epidemiologic studies, including trials, suggest an association between potassium intake and blood pressure (BP). However, the strength and shape of this relationship is uncertain. Methods and Results We performed a meta‐analysis to explore the dose‐response relationship between potassium supplementation and BP in randomized‐controlled trials with a duration ≥4 weeks using the recently developed 1‐stage cubic spline regression model. This model allows use of trials with at least 2 exposure categories. We identified 32 eligible trials. Most were conducted in adults with hypertension using a crossover design and potassium supplementation doses that ranged from 30 to 140 mmol/d. We observed a U‐shaped relationship between 24‐hour active and control arm differences in potassium excretion and BP levels, with weakening of the BP reduction effect above differences of 30 mmol/d and a BP increase above differences ≈80 mmol/d. Achieved potassium excretion analysis also identified a U‐shaped relationship. The BP‐lowering effects of potassium supplementation were stronger in participants with hypertension and at higher levels of sodium intake. The BP increase with high potassium excretion was noted in participants with antihypertensive drug‐treated hypertension but not in their untreated counterparts. Conclusions We identified a nonlinear relationship between potassium intake and both systolic and diastolic BP, although estimates for BP effects of high potassium intakes should be interpreted with caution because of limited availability of trials. Our findings indicate an adequate intake of potassium is desirable to achieve a lower BP level but suggest excessive potassium supplementation should be avoided, particularly in specific subgroups.Keywords
This publication has 89 references indexed in Scilit:
- Meta-Analysis for Linear and Nonlinear Dose-Response Relations: Examples, an Evaluation of Approximations, and SoftwareAmerican Journal of Epidemiology, 2011
- Effects of Potassium Chloride and Potassium Bicarbonate on Endothelial Function, Cardiovascular Risk Factors, and Bone Turnover in Mild HypertensivesHypertension, 2010
- Measuring inconsistency in meta-analysesBMJ, 2003
- Potassium supplementation reduces clinic and ambulatory blood pressure in elderly hypertensive patientsJournal of Hypertension, 1992
- Efficacy of potassium and magnesium in essential hypertension: a double-blind, placebo controlled, crossover study.BMJ, 1990
- Blood pressure response to potassium supplementation in normotensive adults and children.Hypertension, 1987
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986
- Hemodynamic, renal, and hormonal responses to changes in dietary potassium in normotensive and hypertensive man: Long-term antihypertensive effect of potassium supplementation in essential hypertensionJournal of Molecular Medicine, 1985
- Potassium Supplementation in Hypertensive Patients with Diuretic-Induced HypokalemiaThe New England Journal of Medicine, 1985
- Low-sodium diet versus low-sodium/high-potassium diet for treatment of hypertensionJournal of Molecular Medicine, 1984