Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses

Abstract

Objective To conduct a systematic review of the literature and meta-analyses to fill the gaps in knowledge on potassium intake and health.Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, Latin American and Caribbean Health Science Literature Database, and the reference lists of previous reviews.Study selection Randomised controlled trials and cohort studies reporting the effects of potassium intake on blood pressure, renal function, blood lipids, catecholamine concentrations, all cause mortality, cardiovascular disease, stroke, and coronary heart disease were included.Data extraction and synthesis Potential studies were independently screened in duplicate, and their characteristics and outcomes were extracted. When possible, meta-analysis was done to estimate the effects (mean difference or risk ratio with 95% confidence interval) of higher potassium intake by using the inverse variance method and a random effect model.Results 22 randomised controlled trials (including 1606 participants) reporting blood pressure, blood lipids, catecholamine concentrations, and renal function and 11 cohort studies (127 038 participants) reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease in adults were included in the meta-analyses. Increased potassium intake reduced systolic blood pressure by 3.49 (95% confidence interval 1.82 to 5.15) mm Hg and diastolic blood pressure by 1.96 (0.86 to 3.06) mm Hg in adults, an effect seen in people with hypertension but not in those without hypertension. Systolic blood pressure was reduced by 7.16 (1.91 to 12.41) mm Hg when the higher potassium intake was 90-120 mmol/day, without any dose response. Increased potassium intake had no significant adverse effect on renal function, blood lipids, or catecholamine concentrations in adults. An inverse statistically significant association was seen between potassium intake and risk of incident stroke (risk ratio 0.76, 0.66 to 0.89). Associations between potassium intake and incident cardiovascular disease (risk ratio 0.88, 0.70 to 1.11) or coronary heart disease (0.96, 0.78 to 1.19) were not statistically significant. In children, three controlled trials and one cohort study suggested that increased potassium intake reduced systolic blood pressure by a non-significant 0.28 (−0.49 to 1.05) mm Hg.Conclusions High quality evidence shows that increased potassium intake reduces blood pressure in people with hypertension and has no adverse effect on blood lipid concentrations, catecholamine concentrations, or renal function in adults. Higher potassium intake was associated with a 24% lower risk of stroke (moderate quality evidence). These results suggest that increased potassium intake is potentially beneficial to most people without impaired renal handling of potassium for the prevention and control of elevated blood pressure and stroke.

Cruciferous and Total Vegetable Intakes Are Inversely Associated With Subclinical Atherosclerosis in Older Adult Women

“…Individual adjustments for potassium and vegetable‐derived nitrate intakes did, however, attenuate the association between total vegetable intake and CCA‐IMT. This suggests that at least some of the benefit from total vegetable intake was mediated by these components, which are also likely to influence vascular health 43, 49, 50, 51, 52…”

Reducing the Levels of Sodium, Saturated Animal Fat, and Nitrite in Dry-Cured Pork Meat Products: A Major Challenge

“…Very recently, Aburto et al [124] obtained statistical results suggesting that increased potassium intake is potentially beneficial to persons with no kidney disorder for the prevention and control of elevated blood pressure and stroke. We note that according to Castro and Raij [125], human well-being in terms of blood pressure and cardiovascular health may be related to the sodium-to-potassium diet intake ratio rather than to each nutrient rate taken individually.…”

Outcome of a public consultation on the Draft Scientific Opinion of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on Dietary Reference Values for potassium

“…The AI of 3,500 mg (90 mmol) of potassium/day was based on evidence from RCTs for a bloodpressure lowering effect of dietary potassium in adults at doses between 3,500 and 4,700 mg (90-120 mmol)/day (Aburto et al, 2013), on evidence for a lower risk of hypertension associated with intakes of 3,500 mg potassium/day from one prospective cohort study carried out in a European adult population of normotensive people which used multiple 24-hour urine collections to calculate potassium intakes (Kieneker et al, 2014), and on evidence from a dose-response meta-analysis of prospective cohort studies (n=8) for a lower risk of stroke associated with potassium intakes up to 3,500 mg/day; above this value, the inverse relationship was weakened and more uncertain (Larsson et al, 2011). A systematic review and dose-response meta-analysis including all the prospective cohort studies considered by Larsson et al (2011) plus those which had been published thereafter, and which were described individually in the draft opinion released for public consultation, has become available during the consultation period (Vinceti et al, 2016).…”