We establish an equivalence between conformally Einstein-Maxwell Kähler 4-manifolds recently studied in [5,10,35,44,48,49,50] and extremal Kähler 4-manifolds in the sense of Calabi [20] with nowhere vanishing scalar curvature. The corresponding pairs of Kähler metrics arise as transversal Kähler structures of Sasaki metrics compatible with the same CR structure and having commuting Sasaki-Reeb vector fields. This correspondence extends to higher dimensions using the notion of a weighted extremal Kähler metric [7,11,45,46,47], illuminating and uniting several explicit constructions in Kähler and Sasaki geometry. It also leads to new existence and non-existence results for extremal Sasaki metrics, suggesting a link between the notions of relative weighted K-stability of a polarized variety introduced in [11, 47], and relative K-stability of the Kähler cone corresponding to a Sasaki polarization, studied in [18,26].