Potassium treatment for hypertension in patients with high salt intake: A meta-analysis
Abstract
BACKGROUND: Previous metaanalyses of potassium supplementation in patients with hypertension observed little or no benefit, but failed to account the amount of salt intake. OBJECTIVE: To assess the effect on blood pressure of potassium treatment in patients with high salt intake. METHODS: We meta-analyzed studies of patient populations with both high salt and potassium intake. We searched Medline, Google, major journals, Pubmed. Publication bias, lack of heterogeneity, and lack of robustness were assessed using standard procedures for such purposes. RESULTS: After the exclusion of 32 studies 10 studies were left in the meta-analysis. A pooled reduction of systolic blood pressure of -9.5 mmHg (95% confidence interval -10.8 to -8.1) and of diastolic blood pressure -6.4 mmHg (-7.3 to -5.6) was observed. These results were very heterogeneous (I2-values of 94 and 95%). After exclusion of single authored studies the results fell but remained statistically significant, -7.1 mmHg (-8.5 to -5.7), and -4.9 mmHg (-5.8 to -4.0). Heterogeneity of systolic blood pressure was no longer observed (I2-value 24.3%). Some publication bias was observed. CONCLUSIONS: 1. Potassium treatment reduces the blood pressure substantially in hypertensive patients with salt-rich diets. 2. The difference in magnitude of blood pressure reduction between different studies is probably related to the amount of salt intake. 3. Patients with reduced salt intake benefit little from potassium treatment. 4. Major meta-analyses published to date have severely underestimated the potential benefit of potassium treatment in patients with hypertension.
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A recent meta-analysis reported higher mortality with sodium reduction in trials of heart failure patients.
“A recent meta-analysis reported higher mortality with sodium reduction in trials of heart failure patients.35”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [35]
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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
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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) · Circulation · doi:10.1161/cir.0000000000000596 · Cited by 1,127 · see citing works
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Bazzano, L., Green, T., Harrison, T. N., & Reynolds, K. (2013) · Current Hypertension Reports · doi:10.1007/s11906-013-0390-z · Cited by 174 · see citing works
“Indeed, potassium supplementation reduces blood pressure substantially in hypertensive patients with salt-rich diets [62].”
BackgroundThe role of diet for prevention and management of hypertension
Ozemek, C., Laddu, D., Arena, R. A., & Lavie, C. J. (2018) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000532 · Cited by 165 · see citing works
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EFSA Panel on Dietetic Products, N. A. A. (., Turck, D., Bresson, J., Burlingame, B., Dean, T., Fairweather‐Tait, S. J., Heinonen, M., Hirsch‐Ernst, K. I., Mangelsdorf, I., McArdle, H. J., et al. (2016) · EFSA Journal · doi:10.2903/j.efsa.2016.4592 · Cited by 154 · see citing works
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The role of dietary potassium in hypertension and diabetes
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“In this regard, a recent metaanalysis found that potassium treatment reduces the blood pressure substantially in hypertensive patients with salt-rich diets [74].”
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Whelton, P. K., & He, J. (2013) · Current Opinion in Lipidology · doi:10.1097/mol.0000000000000033 · Cited by 90 · see citing works
“In a meta-analysis restricted to 10 trials of K supplementation in persons with a high salt intake, von Bommel and Cleophas [6] reported a pooled reduction in SBP of 9.5 (95% CI, 8.1–10.8) mmHg.”
MethodInfluentialSodium, Potassium, Blood Pressure, and Cardiovascular Disease in Humans
Whelton, P. K. (2014) · Current Hypertension Reports · doi:10.1007/s11906-014-0465-5 · Cited by 88 · see citing works
The Effect of Electrolytes on Blood Pressure: A Brief Summary of Meta-Analyses
Iqbal, S., Klammer, N., & Ekmekçioğlu, C. (2019) · Nutrients · doi:10.3390/nu11061362 · Cited by 63 · see citing works
“Bommel and Cleophas 2012 [42] 10 Crossover and parallel design studies 556 High salt intake, >170 mmol/24h Follow up 8–16 weeks Not available SBP: −9.5 (−10.8 to −8.1) DBP: −6.4 (−7.3 to −5.6) Potassium treatment reduces considerably the blood pressure of hypertensive patients on salt rich diets.”
BackgroundInfluentialClinical perspectives on the rationale for potassium supplementation
Weir, M. R., & Espaillat, R. (2015) · Postgraduate Medicine · doi:10.1080/00325481.2015.1045814 · Cited by 39 · see citing works
“3 mmHg) were observed in the pooled population (Table 3) [22].”
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Agarwal, R. (2012) · Nephrology, Dialysis and Transplantation · doi:10.1093/ndt/gfs384 · Cited by 37 · see citing works
“Likewise, a meta-analysis pointed out the benefits of potassium intake in lowering BP but pointed out the great heterogeneity between studies [27].”
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AlShanableh, Z., & Ray, E. C. (2024) · Frontiers in Physiology · doi:10.3389/fphys.2024.1363975 · Cited by 33 · see citing works
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Singh, D. K., Sinha, N., Bera, O. P., Saleem, S. M., Tripathi, S., Shikha, D., Goyal, M., & Bhattacharya, S. (2021) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_96_21 · Cited by 12 · see citing works
“[12] It has also been reported that supplementation of potassium to hypertensive patients on high salt-rich diets has substantially reduced blood pressure.[13] It is quite clear from the above discussion that the dietary approach to maintaining blood pressure to optimum has a vital role in developing strategies for he…”
BackgroundMeta-analysis and the Scientific Method
Cleophas, T. J., & Zwinderman, A. H. (2017) · Springer eBooks · doi:10.1007/978-3-319-55895-0_3 · Cited by 1 · see citing works
Self-citationImproved Hypertension by Investigating Circadian Rhythm of Blood Pressure
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JUVENTUDE(S) DA PERIFERIA: VULNERABILIDADE E O TRÁFICO DE DROGAS
dos Santos, T. P. (2019) · Anais do XVI Encontro Nacional de Pesquisadores em Serviço Social
Efeito do consumo de frutas in natura e vegetais na pressão arterial de adultos
Pereira, T. S. S., Batista, M. S., & Molina, M. D. C. B. (2019) · Revista Brasileira de Pesquisa em Saúde/Brazilian Journal of Health Research · doi:10.21722/rbps.v20i4.24609
Nutrients Intake and Hypertension
Fantin, F. (2020) · MDPI eBooks · doi:10.3390/books978-3-03928-663-8
Sodium salt substitution for blood pressure in adults with diabetes
Singh, A., Hussain, S., Nelson, M., Huang, L., & Antony, B. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014721
- Authors
- Bommel, E. V., & Cleophas, T.
- Affiliations
- Albert Schweitzer Ziekenhuis (NL)
- Venue
- Int. Journal of Clinical Pharmacology and Therapeutics
- Publisher
- Dustri-Verlgag Dr. Karl Feistle
- Published
- 2012-07-01
- Volume
- 50
- Issue
- 07
- Pages
- 478-482
- ISSN
- 0946-1965 (ISSN-L)
- OpenAlex
- W1976403071
- Cited by
- 23
- References
- 0
- Citations by year
- 2025: 1 · 2024: 1 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 2 · 2015: 2 · 2014: 2 · 2013: 3 · 2012: 1
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Clinical Pharmacology and Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- 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 › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
- Keywords
- potassium supplementation, hypertension, high-salt diet, blood pressure reduction, systolic blood pressure, diastolic blood pressure, publication bias
- MeSH terms
- Diastole, Humans, Hypertension, Systole, Potassium, Dietary, Sodium Chloride, Dietary
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