Association Between Urinary Sodium and Potassium Excretion and Blood Pressure Among Adults in the United States

Jackson, Sandra; Cogswell, Mary E.; Zhao, Lixia; Terry, Ana L; Wang, Chia‐Yih; Wright, Jacqueline D.; King, Sallyann M Coleman; Bowman, Barbara A.; Chen, Te-Ching; Merritt, Robert; Loria, Catherine M.

doi:10.1161/circulationaha.117.029193

Cited by 163 publications

(161 citation statements)

References 32 publications

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“…Similar to other studies, increasing BMI was associated with higher salt consumption . The association found in this study between systolic blood pressure and salt intake in the general population is consistent with other studies . Despite the widespread knowledge that salt consumption is a major nutritional factor associated with SBP level, we did not find statistically significant association between SBP among non‐hypertensive participants in a stratified analysis.…”

Section: Discussionsupporting

confidence: 90%

“…26 The association found in this study between systolic blood pressure and salt intake in the general population is consistent with other studies. [27][28][29] Despite the widespread knowledge that salt consumption is a major nutritional factor associated with SBP level, we did not find statistically significant association between SBP among non-hypertensive participants in a stratified analysis. This result should be interpreted cautiously, because the sample size was small and the design was cross-sectional.…”

Section: Discussionmentioning

confidence: 72%

“…Given the high prevalence of hypertension, approximately 28% in Nepal, intervening to lower dietary salt intake presents an opportunity to realize significant health benefits at the population level. It is estimated that high systolic blood pressure alone accounts for 45% deaths and 46% disability of cardiovascular disease. A recent study estimated that reducing sodium intake by 30% would delay 40 million deaths globally in the next 25 years.…”

Section: Discussionmentioning

confidence: 99%

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Mean dietary salt intake in Nepal: A population survey with 24‐hour urine collections

Neupane

Rijal

Henry

et al. 2020

J of Clinical Hypertension

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High salt (sodium chloride) intake raises blood pressure and increases the risk of developing hypertension, a major risk factor for cardiovascular disease. Little is known about salt intake in Nepal, and no study has estimated salt consumption from 24‐hour urinary sodium excretion. Participants (n = 451) were recruited from the Community‐Based Management of Non‐Communicable Diseases in Nepal (COBIN) cohort in 2018. Salt intake was estimated by analyzing 24‐hour urinary sodium excretion. Multivariate linear regression was used to estimate differences in salt intake. The mean (±SD) age and salt intake were 49.6 (±9.8) years and 13.3 (±4.7) g/person/d, respectively. Higher salt intake was significantly associated with male gender (β for female = −2.4; 95% CI: −3.3, −1.4) and younger age (β10 years = −1.4; 95% CI: −1.4, −0.5) and higher BMI (β = 0.1; 95% CI: 0.0, 0.2). A significant association was also found between increase in systolic blood pressure and higher salt intake (β = 0.3; 95% CI: 0.0, 0.7). While 55% reported that they consumed just the right amount of salt, 98% were consuming more than the WHO recommended salt amount (<5 g/person/d). Daily salt intake in this population was over twice the limit recommended by the WHO, suggesting a substantial need to reduce salt intake in this population. It also supports the need of global initiatives such as WHO's Global Hearts Initiative SHAKE technical package and Resolves to Save Lives for sodium reduction in low‐ and middle‐income countries like Nepal.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Mean dietary salt intake in Nepal: A population survey with 24‐hour urine collections

Neupane

Rijal

Henry

et al. 2020

J of Clinical Hypertension

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“…The relationship between K + and blood pressure in the INTERSALT, PURE, and NHANES studies persisted after adjusting for confounding variables [6,41,42]. The DASH-trial was an intervention study and showed that with constant sodium intake, an increase in dietary K + reduced blood pressure [43].…”

Section: Discussionmentioning

confidence: 97%

Rationale and Design of a Randomized Placebo-Controlled Clinical Trial Assessing the Renoprotective Effects of Potassium Supplementation in Chronic Kidney Disease

Gritter

Vogt

Yeung

et al. 2018

Nephron

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Background/Aims: Dietary potassium (K⁺) has beneficial effects on blood pressure and cardiovascular (CV) outcomes. Recently, several epidemiological studies have revealed an association between urinary K⁺ excretion (as proxy for dietary intake) and better renal outcomes in subjects with chronic kidney disease (CKD). To address causality, we designed the “K⁺ in CKD” study. Methods: The K⁺ in CKD study is a multicenter, randomized, double blind, placebo-controlled clinical trial aiming to include 399 patients with hypertension, CKD stage 3b or 4 (estimated glomerular filtration rate [eGFR] 15–44 mL/min/1.73 m²), and an average eGFR decline > 2 mL/min/1.73 m²/year. As safety measure, all included subjects will start with a 2-week open-label phase of 40 mmol potassium chloride daily. Patients who do not subsequently develop hyperkalemia (defined as serum K⁺ >5.5 mmol/L) will be randomized to receive potassium chloride, potassium citrate (both K⁺ 40 mmol/day), or placebo for 2 years. The primary end point is the difference in eGFR after 2 years of treatment. Secondary end points include other renal outcomes (> 30% decrease in eGFR, doubling of serum creatinine, end-stage renal disease, albuminuria), ambulatory blood pressure, CV events, all-cause mortality, and incidence of hyperkalemia. Several measurements will be performed to analyze the effects of potassium supplementation, including body composition monitoring, pulse wave velocity, plasma renin and aldosterone concentrations, urinary ammonium, and intracellular K⁺ concentrations. Conclusion: The K⁺ in CKD study will demonstrate if K⁺ supplementation has a renoprotective effect in progressive CKD, and whether alkali therapy has additional beneficial effects.

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“…The association of high sodium and low potassium intake with elevated blood pressure is supported by a large body of evidence that includes randomized clinical trials, 4,5 as well as observational cohort studies. 6,7 The Trials of Hypertension Prevention (TOPH), conducted in 1987-1990 and 1990-1995, respectively, showed that reducing dietary sodium in individuals with prehypertension decreased the risk of cardiovascular events and overall mortality up to 20 years after the original trial. [8][9][10] For CVD, two previous meta-analyses of prospective cohort studies detected significant positive relationships between sodium intake and stroke, as well as CVD outcomes.…”

Section: Introductionmentioning

confidence: 99%

Urinary biomarkers and cardiovascular outcomes in the UK Biobank: observational and Mendelian randomization analyses

Zanetti

Bergman

et al. 2018

Preprint

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BackgroundUrinary biomarkers are associated with hypertension and cardiovascular disease (CVD), but the nature of these associations is incompletely understood. MethodsWe performed multivariable-adjusted regression models to assess associations of urinary sodium-potassium ratio (UNa/UK), and urinary albumin adjusted for creatinine (UAlb/UCr) with cardiovascular risk factors, CVD and type 2 diabetes (T2D) in 478,311 participants of the UK Biobank. Further, we studied above associations separately in men and women, and assessed the causal relationships of these kidney biomarkers with cardiovascular outcomes using the two-sample Mendelian randomization (MR) approach. ResultsIn observational analyses, UNa/UK showed significant inverse associations with atrial fibrillation (AF), coronary artery disease (CAD), ischemic stroke, lipid-lowering medication and T2D. In contrast, UAlb/UCr showed significant positive associations with AF, CAD, heart failure, hemorrhagic stroke, lipid-lowering medication and T2D. We found a positive association between UNa/UK and albumin with blood pressure (BP), as well as with adiposity-related measures. Generally, we detected consistent directionality in sex-stratified analyses, with some evidence for sex differences in the associations of urinary biomarkers with T2D and obesity. After correcting for potential horizontal pleiotropy, we found evidence of causal associations of UNa/UK and albumin with systolic BP (betaSBP≥2.63; betaDBP≥0.85 SD increase in systolic BP per SD change UNa/UK and UAlb/UCr; P≤0.038), and of albumin with T2D (odds ratio=1.33 per SD change in albumin, P=0.023). ConclusionOur Mendelian randomization analyses mirror and extend findings from randomized interventional trials which have established sodium intake as a risk factor for hypertension. In addition, we detect a feed-back causal loop between albumin and hypertension, and our finding of a bidirectional causal association between albumin and T2D reflects the well-known nephropathy in T2D.

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Association Between Urinary Sodium and Potassium Excretion and Blood Pressure Among Adults in the United States

Abstract: These cross-sectional results show a strong dose-response association between urinary sodium excretion and blood pressure, and an inverse association between urinary potassium excretion and blood pressure, in a nationally representative sample of US adults.

Cited by 163 publications

References 32 publications

Mean dietary salt intake in Nepal: A population survey with 24‐hour urine collections

Mean dietary salt intake in Nepal: A population survey with 24‐hour urine collections

Rationale and Design of a Randomized Placebo-Controlled Clinical Trial Assessing the Renoprotective Effects of Potassium Supplementation in Chronic Kidney Disease

Urinary biomarkers and cardiovascular outcomes in the UK Biobank: observational and Mendelian randomization analyses

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