Sodium-to-Potassium Ratio and Blood Pressure, Hypertension, and Related Factors

Pérez, Vanessa; Chang, Ellen T.

doi:10.3945/an.114.006783

Cited by 263 publications

(199 citation statements)

References 54 publications

(209 reference statements)

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“…These results are consistent with previous studies [32]. The PURE study found that a 1-SD increment in the estimated sodium-to-potassium ratio (SD=3.26) was associated with increments of 2.3 mmHg in SBP and 0.78 mmHg in DBP.…”

Section: Discussionsupporting

confidence: 83%

Associations of Usual 24-Hour Sodium and Potassium Intakes with Blood Pressure and Risk of Hypertension among Adults in China’s Shandong and Jiangsu Provinces

Chen

et al. 2017

Kidney Blood Press Res

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Background/Aims: High sodium intake and low intake of potassium can increase blood pressure (BP) and risk of developing hypertension. Few studies have examined the association between 24-h urinary sodium and potassium excretion and BP or risk of hypertension in China, and most used only a single 24-h urinary sample. Methods: We analyzed data on 2281 participants aged 18-69 years by using two 24-h urinary sodium and potassium excretions from the supplemental baseline survey of the Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH) project. We used measurement error models to estimate usual intakes, multivariable linear regression to assess their association with B P, and logistic regression to estimate the risk of hypertension. Results: The average usual intakes of sodium and potassium, and the mean sodium-potassium ratio, were 166.9 mmol/day, 25.3 mmol/day, and 6.8, respectively. All three measures were significantly associated with systolic BP (SBP) and diastolic BP (DBP), with an increase of 1.39 mmHg (95% confidence interval [CI] 0.44─2.34) in SBP and 0.94 mmHg (95% CI 0.34─1.55) in DBP for a 1-standard deviation (SD) (25.6mmol/day) increase in sodium intake, a decrease of 1.42 mmHg (95% CI -2.37─ -0.47) in SBP and 0.91 mmHg (95% CI -1.52─ -0.30) in DBP for a 1-SD (3.4 mmol/day) increase in potassium intake, and an increase of 0.97 mmHg (95% CI 0.36─1.58) in SBP and of 0.65 mmHg (95% CI 0.26─1.04) in DBP per unit increase in the sodium-to-potassium ratio. The adjusted odds ratios comparing the risk of hypertension among adults in the highest with those in the lowest quintile differ significantly for potassium (0.51; 95% CI 0.29─0.88) and sodium-to-potassium ratio (1.40; 95% CI 1.01─1.94). Conclusions: Our results suggested that higher sodium and lower potassium intakes are associated with increased BP and risk of hypertension in the Shandong and Jiangsu adults.

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Section: Discussionsupporting

confidence: 83%

Associations of Usual 24-Hour Sodium and Potassium Intakes with Blood Pressure and Risk of Hypertension among Adults in China’s Shandong and Jiangsu Provinces

Chen

et al. 2017

Kidney Blood Press Res

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“…In our study, the sodium-to-potassium ratio (1.9) exceeded the WHO recommendation of a sodium-to-potassium molar ratio of 1:1 [24]. A recent review demonstrated that in various randomized controlled trials the sodium-to-potassium ratio had a stronger association with BP than sodium or potassium alone [25]. In the development of hypertension, excessive sodium and insufficient potassium intake are both shown to play a role since they result in vascular smooth muscle cell contraction which leads to increased peripheral vascular resistance thus causing high BP [26].…”

Section: Discussioncontrasting

confidence: 44%

Relationship between sodium and potassium intake and blood pressure in a sample of overweight adults

et al. 2017

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Objective: The aim of this study was to examine the relationship between sodium and potassium intakes and blood pressure (BP) in a clinical sample.Methods: Secondary analysis of baseline data from 328 participants (mean age: 43.6 ± 8 y, mean body mass index [BMI]: 32.4 ± 4.2 kg/m 2 , mean systolic BP [SBP]/diastolic BP [DBP]: 124.9 ± 14.5/73.3 ± 9.9 mm Hg) of the 12-mo HealthTrack randomized controlled weight loss trial was conducted. Resting BP and 24-h urine sodium and potassium were measured. Dietary intake was evaluated with 4-d food records and selfreported diet histories.Results: Urinary sodium was positively correlated (Spearman's rho) with SBP (r = 0.176; P = 0.001) and DBP (r = 0.150; P = 0.003). The ratio of sodium to potassium was positively correlated with SBP (r = 0.1; P = 0.035). Urinary sodium (F [4,323] = 20.381; P < 0.0005; adjusted R 2 = 0.231) and sodium-to-potassium ratio (F[4,323] = 25.008; P < 0.0005; adjusted R 2 = 0.227) significantly predicted SBP after controlling for age, sex, BMI, and hypertension medication use. Dietary sodium and potassium significantly predicted urinary sodium (B = 0.33, t = 4.032, P < 0.01) and potassium (B = 0.67, t = 8.537, P < 0.01) excretion, respectively, after adjustment for energy and BMI. Median dietary sodium intake was 3197 mg/d and median dietary potassium intake was 2886 mg/d. Cereal-based products and dishes were the major contributors (22%) to total sodium intake.Conclusions: In the present study, a high dietary sodium intake and high sodium-to-potassium ratio predicted high SBP. This suggests a need to focus dietary advice on reduction of sources of sodium and increasing sources of potassium in weight loss interventions to improve BP control. P<0.01) and potassium (B=0.67, t=8.537, P<0.01) excretion respectively after adjustment for energy and BMI. Median dietary sodium intake was 3197 mg/day and median dietary potassium intake was 2886 mg/day. Cereal based products and dishes were the major contributors (22%) to total sodium intake.Conclusions: In our sample, a high dietary sodium intake and high sodium-to-potassium ratio predicted high SBP. This suggests a need to focus dietary advice on reduction of sources of sodium and increasing sources of potassium in weight loss interventions in order to improve BP control.

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“…The mean urinary sodium to potassium ratio was high in this study (3.1 ± 1.3). Multiple other studies have shown stronger correlations between this ratio and the development of hypertension than with either the urinary sodium or potassium alone [21], therefore, this ratio should be taken into consideration in future studies. Most of the study participants were either overweight (41%) or obese (25%).…”

Section: Discussionmentioning

confidence: 99%

Dietary salt consumption and the knowledge, attitudes and behavior of healthy adults: a cross-sectional study from Jordan

AlAwwa

Dagash

Saleh

et al. 2018

Libyan Journal of Medicine

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High dietary sodium is recognized as a silent killer responsible for 2.3 million deaths worldwide in 2010 predominantly secondary to hypertension and its complications. Although high salt consumption is considered a worldwide public health problem, its magnitude is highly variable among different communities; therefore, it is important to study locally. This study aimed to evaluate habitual salt consumption, its important correlations, as well as the knowledge, attitude, and behavior of healthy Jordanian citizens. As potassium consumption is highly correlated and important we aimed to study both jointly. In this descriptive cross-sectional study we enrolled 103 healthy adult Jordanian citizens. All participants were interviewed for questionnaire filling, physical examination, and instructed on proper 24-hour urine collection procedure. We measured sodium and potassium concentration in the provided controlled 24-hour urine collection samples, as it is presently considered the gold standard for evaluating daily intake. The results showed an average sodium intake of 179 mmol (4.1 g) per day [higher in males at 186 mmol (4.3 g) vs. 173 mmol (4.0 g) for females], significantly above the current WHO recommendations, though only 8% regularly add salt to food. Ironically, most participants (82%) believe their salt consumption was appropriate and only 29% thought they may benefit from reducing salt intake. On the other hand, potassium intake is far below the current WHO recommendations. High sodium and low potassium intake have synergistic adverse effects on public health that is not currently addressed in Jordan. We conclude that Jordanian citizens currently consume high sodium and low potassium diet and are mostly unaware of its negative impact on their health. Hence, it is crucial for healthcare providers to intervene and adopt long-term strategies to control salt intake to reduce its negative effects in Jordan and elsewhere.

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Sodium-to-Potassium Ratio and Blood Pressure, Hypertension, and Related Factors

Cited by 263 publications

References 54 publications

Associations of Usual 24-Hour Sodium and Potassium Intakes with Blood Pressure and Risk of Hypertension among Adults in China’s Shandong and Jiangsu Provinces

Associations of Usual 24-Hour Sodium and Potassium Intakes with Blood Pressure and Risk of Hypertension among Adults in China’s Shandong and Jiangsu Provinces

Relationship between sodium and potassium intake and blood pressure in a sample of overweight adults

Dietary salt consumption and the knowledge, attitudes and behavior of healthy adults: a cross-sectional study from Jordan

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