Dietary Potassium and Cardiovascular Disease: Clinical Applications

Addison WLT. The use of sodium chloride, potassium chloride, sodium bromide and potassium bromide in cases of arterial hypertension which are amenable to potassium chloride. Can Med Assoc J 1928; 18: 281–285.

Linas SL. The role of potassium in the pathogenesis and treatment of hypertension. Kidney Int 1991; 39: 771–786.

Clinical and pathophysiological data on the role of potassium in the pathogenesis and treatment of hypertension and stroke are summarised.

Saggar-Malik AK Cappuccio FP. Potassium supplements and potassium sparing diuretics. A review and guide to appropriate use. Drugs 1993; 46: 988–1008.

The authors reviewed the role of potassium supplements in several pathological conditions from a pharmacological and clinical point of view. The usefulness and safety of potassium-sparing diuretics are also discussed.

Krishna GG. Role of potassium in the pathogenesis of hypertension. Am J Med Sci 1994; 307 (suppl 1): S21–S25.

In this review the pathogenetic aspects of the potassium-blood pressure relationship are addressed.

Siani A Strazzullo P. Relevance of dietary potassium intake to antihypertensive drug treatment. In: Laragh JH Brenner BM (editors): Hypertension: pathophysiology diagnosis and management New York: Raven Press; 1994. pp. 2727–2737.

The authors analysed the relationship between potassium intake and blood pressure, with particular emphasis on the interaction between potassium intake and antihypertensive drug therapy.

Young DB Lin H McCabe RD. Potassium's cardiovascular protective mechanisms. Am J Physiol 1995; 268: R825–R837.

A comprehensive and detailed exposition of the mechanisms underlying the possible cardiovascular protective effect of potassium. The results of experimental studies on animal models of cardiovascular disease are clearly discussed.

Siani A Strazzullo P. Why and how to increase dietary potassium intake. Nutr Metab Cardiovasc Dis 1996; 6: 245–254.

A review of the efficacy and applicability of population-wide nutritional strategies aimed at enhancing dietary intake of potassium.

Tobian L. Dietary sodium chloride and potassium have effects on the pathophysiology of hypertension in humans and animals. Am J Clin Nutr 1997; 65 (suppl 2): 606S–611S.

This review addresses, in particular, the effect of potassium feeding in animal models of salt-induced hypertension.

Barri YM Wingo CS. The effects of potassium depletion and supplementation on blood pressure: a clinical review. Am J Med Sci 1997; 314: 37–40.

An updated review of the clinical issues related to the effects on blood pressure of potassium depletion and supplementation, with therapeutic recommendations.

Truesdell DD Whitney EN Acosta PB. Nutrients in vegetarian foods. J Am Diet Assoc 1964; 84: 28–35.

Arbeit ML Niklas TA Berenson GS. Consideration of dietary sodium/potassium/energy ratios of selected foods. J Am Coll Nutr 1992; 11: 210–222.

In this study over 100 food items were classified according to their sodium and potassium contents and energy densities. The information provided could help in the identification of food options for specific dietary goals.

Carnovale E Marietta L (editor). Tabelle di composizione degli alimenti. Rome: Istituto Nazionale della Nutrizione; 1997.

Updated tables of compositions of foods.

Kopyt N Dalal F. Renal retention of potassium in fruit. N Engl J Med 1985; 313: 582–583.

Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24-hour urinary sodium and potassium excretion. BMJ 1988; 297: 319–328.

A large worldwide epidemiological investigation on electrolytes and other factors related to blood pressure. Its results confirmed, with a large sample and carefully standardized procedures, the existence of an inverse relationship between urinary excretion of potassium and blood pressure.

Siani A Iacoviello L Giorgione N lacone R Strazzullo P. Comparison of variability of urinary sodium, potassium and calcium in free-living men. Hypertension 1989; 13: 38–42.

Thier SO. Potassium physiology. Am J Med 1986; 80 (suppl 4A): 3–7.

Berns JS Hayslett JP. Renal and extrarenal excretion of potassium. In: Seldin DW Giebisch G (editors): The regulation of potassium balance. New York: Raven Press; 1989. pp. 157–174.

Schachter J Harper PH Radin ME Caggiula AW McDonald RH Diven WF. Comparison of sodium and potassium intake with excretion. Hypertension 1980; 2: 695–699.

Clark AJ Mossholder S. Sodium and potassium intake measurements: dietary methodology problems. Am J Clin Nutr 1986; 43: 470–476.

In this study the methodological problems encountered in the measurement of dietary intake of electrolytes are carefully addressed.

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: 287–291.

Lever AF Beretta-Piccoli C Brown JJ Davies DL Fraser R Robertson JI. Sodium and potassium in essential hypertension. BMJ 1981; 283: 463–468.

Khaw KT Barrett-Connor E. Dietary potassium and blood pressure in a population. Am J Clin Nutr 1984; 39: 963–968.

Khaw KT Barrett-Connor E. The association between blood pressure, age, and dietary sodium and potassium: a population study. Circulation 1988; 77: 53–61.

Stamler J Caggiula AW Grandits GA. Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. Am J Clin Nutr 1997; 65 (suppl 1): 338S–365S.

Reed D McGee D Yano K Hankin J. Diet, blood pressure, and multicollinearity. Hypertension 1985; 7: 405–410.

Cappuccio FP MacGregor GA. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens 1991; 9: 465–473.

The first meta-analysis of the effect of oral potassium supplementation on blood pressure. Its results supported the hypothesis that potassium supplements exert a statistically significant and biologically relevant blood-pressure-lowering effect on humans.

Whelton PK He J Cutler JA Brancati FL Appel U Follmann D . Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA 1997; 277: 1624–1632.

An updated and comprehensive meta-analysis of all randomized controlled trials of oral potassium supplementation. Its results further supported the conclusion that increasing intake of potassium is to be considered an effective measure in the prevention and treatment of high blood pressure.

Smith SJ Markandu ND Sagnella GA MacGregor GA. Moderate potassium chloride supplementation in essential hypertension: is it additive to moderate sodium restriction? BMJ 1985; 290: 110–113.

Grimm RH Jr Neaton JD Elmer PJ Svendsen KH Levin J Segal M . The influence of oral potassium chloride on blood pressure in hypertensive men on a low-sodium diet. N Engl J Med 1990; 322: 569–574.

Stamler J Rose G Elliott P Dyer A Marmot M Kesteloot H . Findings of the International Cooperative INTERSALT Study. Hypertension 1991; 17 (suppl 1): I9–I15.

Svetkey LP Yarger WE Feussner JR DeLong E Klotman PE. Double-blind, placebo-controlled trial of potassium chloride in the treatment of mild hypertension. Hypertension 1987; 9: 444–450.

Brancati FL Appel U Seidler AJ Whelton PK. Effect of potassium supplementation on blood pressure in African Americans on a low-potassium diet. A randomized, double-blind, placebo-controlled trial. Arch Intern Med 1996; 8: 61–67.

Weinberger MH. Hypertension in African Americans: the role of sodium chloride and extracellular fluid volume. Semin Nephrol 1996; 16: 110–116.

Watson RL Langford HG Abernethy J Barnes TY Watson MJ. Urinary electrolytes, body weight, and blood pressure. Pooled cross-sectional results among four groups of adolescent females. Hypertension 1980; 2: 93–98.

Frisancho AR Leonard WR Bollettino LA. Blood pressure in blacks and whites and its relationship to dietary sodium and potassium intake. J Chron Dis 1984; 37: 515–519.

Sacks FM Willett WC Smith A Brown LE Rosner B Moore TJ. Effect on blood pressure of potassium, calcium and magnesium in women with low habitual intake. Hypertension 1998; 31: 131–138.

Swales JD. Salt substitutes and potassium intake. BMJ 1991; 303: 1084–1085.

Siani A Strazzullo P Giacco A Pacioni D Celentano E Mancini M. Increasing the dietary potassium intake reduces the need for antihypertensive medication. Ann Intern Med 1991; 115: 753–759.

Authors of this long-term controlled dietary-intervention trial demonstrated the feasibility and the efficacy of a dietary intervention aimed at increasing intake of potassium from natural foods. A significant reduction of antihypertensive therapy was observed for patients consuming the potassium-rich diet in comparison with those in a control group.

Appel U Moore TJ Obarzanek E Vollmer WM Svetkey LP Sacks FM . A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 1997; 336: 1117–1124.

Authors of this randomized controlled trial tested the effects of complex dietary patterns on blood pressure with a large sample of patients with mild hypertension. Its results showed that a diet rich in fruits, vegetables and low-fat dairy foods and with less than normal amounts of saturated total fat can significantly lower blood pressure.

National Heart, Lung and Blood Institute. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997; 157: 2413–2446.

USA Department of Agriculture, USA Department of Health and Human Services. Dietary guidelines for Americans. Fourth edition. Washington: USA Government Printing Office; 1995.

Stamler R. Implications of the INTERSALT Study. Hypertension 1991; 17 (suppl 1): I16–I20.

Khaw KT Barrett-Connor E. Dietary potassium and stroke-associated mortality. N Engl J Med 1987; 316: 235–240.

In this prospective investigation of dietary factors associated with cardiovascular morbidity and mortality, the authors reported that 12-year stroke-related mortality was significantly and inversely related to baseline intake of potassium.

Xie JX Sasaki S Joossens JV Kesteloot H. The relationship between urinary cations obtained from the INTERSALT study and cerebrovascular mortality. J Hum Hypertens 1992; 6: 17–21.

Sasaki S Zhang XH Kestellot H. Dietary sodium, potassium, saturated fat, alcohol, and stroke mortality. Stroke 1995; 26: 783–789.

Gillman MW Cupples A Gagnon D Posner B Millen Ellison R Curtis Castelli WP. Protective effect of fruits and vegetables on development of stroke in men. JAMA 1995; 273: 1113–1117.

Authors of this study examined the effect of consumption of fruit and vegetables on stroke incidence among 832 middle-aged men participating in the Framingham Study over 20 years of follow-up. The authors concluded that intake of fruit and vegetables protects men against the risk of stroke.

Tunstall-Pedoe H Woodward M Tavendale R Brook RA McCluskey MK. Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish heart health study: cohort study. BMJ 1997; 315: 722–729.

Tobian L Lange J Ulm K Wold L Iwai J. Potassium reduces cerebral hemorrhage and death in hypertensive rats even when blood pressure is not lowered. Hypertension 1985; 7 (suppl 1): 110–114.

Tobian L Macneil D Johnson MA Ganguli MC Iwai J. Potassium protection against lesions of the renal tubules arteries and glomeruli and nephron loss in salt-loaded Dahl rats. Hypertension 1984; 6 (suppl 1): 170–176.

Tobian L Jahner TM Johnson MAK. Atherosclerotic cholesterol ester deposition is markedly reduced with a high-potassium diet. J Hypertens 1989; 7 (suppl 6): S244–S245.

Sugimoto K Tobian L Ishimitsu T Lange J. High potassium diets greatly increase the release of growth-inhibiting agents from aortae of stroke-prone spontaneously hypertensive rats thereby partially explaining reduced aortic wall thickening. J Hypertens 1991; 9 (suppl 6): 176–177.

Ishimitsu T Tobian L Sugimoto K Everson T. High potassium diets reduce vascular and plasma lipid peroxides in stroke-prone spontaneously hypertensive rats. Clin Exp Hypertens 1996; 18: 659–673.

Ishimitsu T Tobian L. High potassium diets reduce endothelial permeability in stroke-prone spontaneously hypertensive rats. Clin Exp Pharmacol Physiol 1996; 23: 241–245.

Ishimitsu T Tobian L Sugimoto K Lange JM. High potassium diets reduce macrophage adherence to the vascular wall in stroke-prone spontaneously hypertensive rats. J Vasc Res 1995; 32: 406–412.

McCabe RD Backarich MA Srivastave K Young DB. Potassium inhibits free radical formation. Hypertension 1994; 24: 77–82.

McCabe RD Young DB. Potassium inhibits cultured vascular smooth muscle cell proliferation. Am J Hypertens 1994; 7: 346–350.

Lin H Young DB. Interaction between plasma potassium and epinephrine in coronary thrombosis in dog. Circulation 1994; 89: 331–338.

Taddei S Mattei P Virdis A Sudano I Ghiadoni L Salvetti A. Effect of potassium on vasodilation to acetylcholine in essential hypertension. Hypertension 1994; 23: 485–490.