Association of Urinary Sodium and Potassium Excretion with Blood Pressure
Open accessAbstract
BACKGROUND: Higher levels of sodium intake are reported to be associated with higher blood pressure. Whether this relationship varies according to levels of sodium or potassium intake and in different populations is unknown. METHODS: We studied 102,216 adults from 18 countries. Estimates of 24-hour sodium and potassium excretion were made from a single fasting morning urine specimen and were used as surrogates for intake. We assessed the relationship between electrolyte excretion and blood pressure, as measured with an automated device. RESULTS: Regression analyses showed increments of 2.11 mm Hg in systolic blood pressure and 0.78 mm Hg in diastolic blood pressure for each 1-g increment in estimated sodium excretion. The slope of this association was steeper with higher sodium intake (an increment of 2.58 mm Hg in systolic blood pressure per gram for sodium excretion >5 g per day, 1.74 mm Hg per gram for 3 to 5 g per day, and 0.74 mm Hg per gram for <3 g per day; P<0.001 for interaction). The slope of association was steeper for persons with hypertension (2.49 mm Hg per gram) than for those without hypertension (1.30 mm Hg per gram, P<0.001 for interaction) and was steeper with increased age (2.97 mm Hg per gram at >55 years of age, 2.43 mm Hg per gram at 45 to 55 years of age, and 1.96 mm Hg per gram at <45 years of age; P<0.001 for interaction). Potassium excretion was inversely associated with systolic blood pressure, with a steeper slope of association for persons with hypertension than for those without it (P<0.001) and a steeper slope with increased age (P<0.001). CONCLUSIONS: In this study, the association of estimated intake of sodium and potassium, as determined from measurements of excretion of these cations, with blood pressure was nonlinear and was most pronounced in persons consuming high-sodium diets, persons with hypertension, and older persons. (Funded by the Heart and Stroke Foundation of Ontario and others.).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A systolic blood pressure increase of 2.11 mm Hg occurs for each 1-g increment in estimated sodium excretion.
“A large prospective, epidemiologic study found a systolic blood pressure increase of 2.11 mm Hg for each 1-g increment in estimated sodium excretion [11].”
From The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy (2024) · cites this paper as [11]
In PURE, both high (>6 g/day) and low (<3 g/day) sodium excretion were associated with higher mortality and CVD events compared to average (4.00-5.99 g/day) sodium excretion, despite a positive association between sodium excretion and BP.
“PURE study findings (263) are consistent with this evidence, with both high (> 6 grams/day) and low (< 3 grams/day) sodium excretion associated with higher mortality and CVD events compared to average (4.00–5.99 grams/day) sodium excretion despite a positive association between sodium excretion and BP (251,263).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [251]
Human epidemiologic and feeding studies demonstrate that higher K+ intake not only lowers BP but also reduces salt sensitivity.
“Human epidemiologic and feeding studies further demonstrate that higher K + intake not only lowers BP but also reduces salt sensitivity [ 181 – 183 ]”
From Sex differences in potassium regulation: evidence, molecular mechanisms and clinical implications (2026) · cites this paper as [183]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., McQueen, M., Budaj, A., Pais, P., Varigos, J., et al. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17018-9 · Cited by 12,026 · see citing works
Self-citationSacks, F. M., Svetkey, L. P., Vollmer, W. M., Appel, L. J., Bray, G. A., Harsha, D., Obarzanek, E., Conlin, P. R., Miller, E. R., Simons-Morton, D. G., et al. (2001) · New England Journal of Medicine · doi:10.1056/nejm200101043440101 · Cited by 5,638 · see citing works
O'Donnell, M. J., Xavier, D., Liu, L., Zhang, H., Chin, S. L., Rao-Melacini, P., Rangarajan, S., Islam, S., Pais, P., McQueen, M. J., et al. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60834-3 · Cited by 3,448 · see citing works
Self-citationEckel, R. H., Jakicic, J. M., Ard, J. D., de Jesus, J. M., Miller, N. H., Hubbard, V. S., Lee, I.-M., Lichtenstein, A. H., Loria, C. M., Millen, B. E., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437740.48606.d1 · Cited by 2,261 · see citing works
He, F. J., Li, J., & MacGregor, G. A. (2013) · BMJ · doi:10.1136/bmj.f1325 · Cited by 1,358 · see citing works
Yusuf, S., Islam, S., Chow, C. K., Rangarajan, S., Dagenais, G., Diaz, R., Gupta, R., Kelishadi, R., Iqbal, R., Avezum, A., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61215-4 · Cited by 964 · see citing works
Self-citationAburto, N., Hanson, S., Gutiérrez, H., Hooper, L., Elliott, P., & Cappuccio, F. P. (2013) · BMJ · doi:10.1136/bmj.f1378 · Cited by 956 · see citing works
Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events
O'Donnell, M., Mente, A., Rangarajan, S., McQueen, M. J., Wang, X., Liu, L., Yan, H., Lee, S. F., Mony, P., Devanath, A., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1311889 · Cited by 886 · see citing works
Self-citationBlood Pressure and Nutrient Intake in the United States
McCarron, D. A., Morris, C. D., Henry, H. J., & Stanton, J. L. (1984) · Science · doi:10.1126/science.6729459 · Cited by 682 · see citing works
Teo, K. K., Chow, C. K., Vaz, M. A. P., Rangarajan, S., & Yusuf, S. (2009) · American Heart Journal · doi:10.1016/j.ahj.2009.04.019 · Cited by 603 · see citing works
Self-citationKawasaki, T., Itoh, K., Uezono, K., & Sasaki, H. (1993) · Clinical and Experimental Pharmacology and Physiology · doi:10.1111/j.1440-1681.1993.tb01496.x · Cited by 516 · see citing works
Sodium and potassium intake and balance in adults consuming self-selected diets
Holbrook, J. T., Patterson, K. Y., Bodner, J. E., Douglas, L. W., Veillon, C., Kelsay, J., Mertz, W., & Smith, J. (1984) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/40.4.786 · Cited by 396 · see citing works
Mente, A., O'Donnell, M. J., Dagenais, G. R., Wielgosz, A. T., Lear, S. A., McQueen, M. J., Jiang, Y., Wang, X., Bo, J., Calik, K., et al. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000122 · Cited by 204 · see citing works
Self-citationSmith, W. C., Crombie, I. K., Tavendale, R., Gulland, S. K., & Tunstall-Pedoe, H. D. (1988) · BMJ · doi:10.1136/bmj.297.6644.329 · Cited by 129 · see citing works
Havas, S., Roccella, E. J., & Lenfant, C. J. M. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.1.19 · Cited by 93 · see citing works
Urinary Potassium Is a Clinically Useful Test to Detect a Poor Quality Diet
Mente, A., Irvine, E. J., Honey, R. J. D., & Logan, A. G. (2009) · Journal of Nutrition · doi:10.3945/jn.108.098319 · Cited by 68 · see citing works
Self-citationKawamura, M., Kusano, Y., Takahashi, T., Owada, M., & Sugawara, T. (2006) · Hypertension Research · doi:10.1291/hypres.29.397 · Cited by 57 · see citing works
Chien, K., Hsu, H., Chen, P., Su, T., Chang, W., Chen, M.-F., & Lee, Y. (2008) · Journal of Hypertension · doi:10.1097/hjh.0b013e328306a0a7 · Cited by 56 · see citing works
Role of Sodium Intake in the Progression of Chronic Kidney Disease
Ritz, E., Koleganova, N., & Piecha, G. (2009) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2008.10.007 · Cited by 51 · see citing works
Townsend, M. T., FULGONIIII, V., Stern, J. H., et al. (2005) · American Journal of Hypertension · doi:10.1016/j.amjhyper.2004.09.017 · Cited by 44 · see citing works
Bjorkman, D. (2001) · Journal watch · doi:10.1056/jg200110100000002 · Cited by 22 · see citing works
Sodium, Potassium, and Blood Pressure
Weinberger, M. H. (1997) · American Journal of Hypertension · doi:10.1016/s0895-7061(97)00074-5 · Cited by 16 · see citing works
Townsend, M. S., Fulgoni, V. L., Stern, J. S., et al. (2005) · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000065 · Cited by 7,391 · see citing works
Yusuf, S., Joseph, P., Rangarajan, S., Islam, S., Mente, A., Hystad, P., Brauer, M., Kutty, V. R., Gupta, R., Wielgosz, A., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(19)32008-2 · Cited by 2,017 · see citing works
Self-citationDehghan, M., Mente, A., Zhang, X., Swaminathan, S., Li, W., Mohan, V., Iqbal, R., Kumar, R., Wentzel-Viljoen, E., Rosengren, A., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)32252-3 · Cited by 1,101 · see citing works
Self-citationWhelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000596 · Cited by 1,127 · see citing works
Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events
O'Donnell, M., Mente, A., Rangarajan, S., McQueen, M. J., Wang, X., Liu, L., Yan, H., Lee, S. F., Mony, P., Devanath, A., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1311889 · Cited by 886 · see citing works
Self-citationNutritional Management of Chronic Kidney Disease
Kalantar-Zadeh, K., & Fouque, D. (2017) · New England Journal of Medicine · doi:10.1056/nejmra1700312 · Cited by 636 · see citing works
Anand, S. S., Hawkes, C., de Souza, R. J., Mente, A., Dehghan, M., Nugent, R., Zulyniak, M. A., Weis, T., Bernstein, A. M., Krauss, R. M., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.07.050 · Cited by 507 · see citing works
“99 g/day, despite an overall positive association between sodium excretion and blood pressure (251,263).”
BackgroundSelf-citationMente, A., O'Donnell, M., Rangarajan, S., Dagenais, G., Lear, S., McQueen, M., Diaz, R., Avezum, A., Lopez-Jaramillo, P., Lanas, F., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30467-6 · Cited by 483 · see citing works
Self-citationSalt Sensitivity of Blood Pressure: A Scientific Statement From the American Heart Association
Elijovich, F., Weinberger, M. H., Anderson, C. A. M., Appel, L. J., Bursztyn, M., Cook, N. R., Dart, R. A., Newton-Cheh, C. H., Sacks, F. M., & Laffer, C. L. (2016) · Hypertension · doi:10.1161/hyp.0000000000000047 · Cited by 482 · see citing works
Trieu, K., Neal, B., Hawkes, C., Dunford, E., Campbell, N., Rodriguez-Fernandez, R., Legetic, B., McLaren, L., Barberio, A., & Webster, J. (2015) · PLOS ONE · doi:10.1371/journal.pone.0130247 · Cited by 451 · see citing works
“Since the last review, a series of recent research reports have provided further support for salt reduction [3, 6–9] and while several widely critiqued observational analyses have contested the nature of the association between salt and vascular outcomes [10–13] the totality of the evidence supports efforts to achieve…”
ResultTerker, A. S., Zhang, C., McCormick, J. A., Lazelle, R. A., Zhang, C., Meermeier, N. P., Siler, D. A., Park, H. J., Fu, Y., Cohen, D. M., et al. (2015) · Cell Metabolism · doi:10.1016/j.cmet.2014.12.006 · Cited by 457 · see citing works
Kario, K., Okura, A., Hoshide, S., & Mogi, M. (2024) · Hypertension Research · doi:10.1038/s41440-024-01622-w · Cited by 425 · see citing works
Ndanuko, R. N., Tapsell, L. C., Charlton, K. E., Neale, E. P., & Batterham, M. J. (2016) · Advances in Nutrition · doi:10.3945/an.115.009753 · Cited by 403 · see citing works
Sodium-to-potassium ratio and blood pressure, hypertension, and related factors
Perez, V., & Chang, E. T. (2014) · Advances in Nutrition · doi:10.3945/an.114.006783 · Cited by 334 · see citing works
Farquhar, W. B., Edwards, D. G., Jurkovitz, C. T., & Weintraub, W. S. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.12.039 · Cited by 348 · see citing works
Mente, A., O'Donnell, M., Rangarajan, S., McQueen, M., Dagenais, G., Wielgosz, A., Lear, S., Ah, S. T. L., Wei, L., Diaz, R., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31376-x · Cited by 332 · see citing works
Self-citationMente, A., Dehghan, M., Rangarajan, S., McQueen, M., Dagenais, G., Wielgosz, A., Lear, S., Li, W., Chen, H., Yi, S., et al. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30283-8 · Cited by 268 · see citing works
Self-citationBinia, A., Jaeger, J., Hu, Y., Singh, A., & Zimmermann, D. (2015) · Journal of Hypertension · doi:10.1097/hjh.0000000000000611 · Cited by 245 · see citing works
Sodium Intake and Cardiovascular Health
O’Donnell, M., Mente, A., & Yusuf, S. (2015) · Circulation Research · doi:10.1161/circresaha.116.303771 · Cited by 208 · see citing works
Self-citationRied, K., & Fakler, P. (2014) · Integrated Blood Pressure Control · doi:10.2147/ibpc.s51434 · Cited by 198 · see citing works
Regulation of the Renal NaCl Cotransporter and Its Role in Potassium Homeostasis
Hoorn, E. J., Gritter, M., Cuevas, C. A., & Fenton, R. A. (2020) · Physiological Reviews · doi:10.1152/physrev.00044.2018 · Cited by 163 · see citing works
Lifestyle modifications for preventing and treating heart failure
Aggarwal, M., Bozkurt, B., Panjrath, G., Aggarwal, B., Ostfeld, R. J., Barnard, N. D., Gaggin, H., Freeman, A. M., Allen, K., Madan, S., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.08.2160 · Cited by 162 · see citing works
Sodium in the microenvironment regulates immune responses and tissue homeostasis
Müller, D. N., Wilck, N., Haase, S., Kleinewietfeld, M., & Linker, R. A. (2019) · Nature Reviews Immunology · doi:10.1038/s41577-018-0113-4 · Cited by 149 · see citing works
Potassium Homeostasis: The Knowns, the Unknowns, and the Health Benefits
McDonough, A. A., & Youn, J. H. (2017) · Physiology · doi:10.1152/physiol.00022.2016 · Cited by 146 · see citing works
Paula, T. P., Viana, L. V., Neto, A. T. Z., Leitão, C. B., Gross, J. L., & Azevedo, M. J. (2015) · The Journal of Clinical Hypertension · doi:10.1111/jch.12597 · Cited by 115 · see citing works
Park, J., Kwock, C., & Yang, Y. (2016) · Nutrients · doi:10.3390/nu8080482 · Cited by 63 · see citing works
Wang, M.-Y., Zhang, Z., Zhao, S., Onodera, T., Sun, X.-N., Zhu, Q., Li, C., Li, N., Chen, S., Paredes, M., et al. (2024) · Cell Metabolism · doi:10.1016/j.cmet.2023.12.024 · Cited by 52 · see citing works
The effect of a dietary portfolio compared to a DASH-type diet on blood pressure
Jenkins, D. J. A., Jones, P. J., Frohlich, J., Lamarche, B., Ireland, C., Nishi, S. K., Srichaikul, K., Galange, P., Pellini, C., Faulkner, D., et al. (2015) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2015.08.006 · Cited by 45 · see citing works
Sex differences in potassium regulation: evidence, molecular mechanisms and clinical implications
Al-Qusairi, L. (2026) · Biology of Sex Differences · doi:10.1186/s13293-026-00862-4 · Cited by 3 · see citing works
- Authors
- Mente, A., O'Donnell, M. J., Rangarajan, S., McQueen, M. J., Poirier, P., Wielgosz, A., Morrison, H., Li, W., Wang, X., Di, C., Mony, P., Devanath, A., Rosengren, A., Oguz, A., Zatonska, K., Yusufali, A. H., Lopez-Jaramillo, P., Avezum, A., Ismail, N., Lanas, F., Puoane, T., Diaz, R., Kelishadi, R., Iqbal, R., Yusuf, R., Chifamba, J., Khatib, R., Teo, K., & Yusuf, S.
- Affiliations
- Population Health Research Institute (CA)
- Ollscoil na Gaillimhe – University of Galway (IE)
- Université Laval (CA)
- University of Ottawa (CA)
- Public Health Agency of Canada (CA)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- University of Gothenburg (SE)
- Universidad de La Frontera (CL)
- University of the Western Cape (ZA)
- Isfahan University of Medical Sciences (IR)
- Aga Khan University (PK)
- Independent University, Bangladesh (BD)
- University of Zimbabwe (ZW)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2014-08-14
- Volume
- 371
- Issue
- 7
- Pages
- 601-611
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2135383573
- Cited by
- 858
- References
- 25
- Citations by year
- 2026: 32 · 2025: 45 · 2024: 54 · 2023: 75 · 2022: 81 · 2021: 83 · 2020: 78 · 2019: 68 · 2018: 79 · 2017: 83 · 2016: 68 · 2015: 78 · 2014: 28 · 2013: 1 · 2012: 1
- FWCI
- 79.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Repositorio Universidad de Santander (submittedVersion, cc-by-nc-nd)
- Omeka S (Universidad de La Frontera) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- sodium excretion, potassium excretion, blood pressure, hypertension, sodium intake, potassium intake, nonlinear dose-response relationship, age differences, high-salt diet, electrolyte excretion
- MeSH terms
- Adult, Age Factors, Blood Pressure, Diet, Female, Humans, Hypertension, Male, Middle Aged, Potassium, Sensitivity and Specificity, Sodium, Sodium, Dietary, Linear Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
