Why potassium may be the missing piece in BP control

Clinical takeaway: Continue recommending sodium reduction for patients with hypertension, but also emphasize increasing potassium-rich foods (when not contraindicated, such as in advanced kidney disease) because evidence suggests the combination may lower blood pressure more effectively than sodium reduction alone.

A multidisciplinary group of physicians, hypertension researchers, nutrition scientists, and food science experts argues that public health efforts to control hypertension should place equal emphasis on increasing dietary potassium and reducing sodium, citing emerging mechanistic, clinical, and population-based evidence. The authors stress that sodium reduction remains the foundation of hypertension management but contend that a dual-focus approach is more consistent with current evidence.

Published as a perspective in The American Journal of Clinical Nutrition, the article reviews current evidence on sodium and potassium, implementation challenges, and opportunities to strengthen public health strategies for hypertension prevention and cardiovascular risk reduction. The authors emphasize that sodium reduction remains the cornerstone of hypertension management but say emerging evidence supports a broader approach that also prioritizes increasing potassium intake.

Hypertension affects more than 1.28 billion adults worldwide, and while sodium intake remains above recommended levels in many countries, potassium intake is often well below optimal. The authors note that potassium promotes sodium excretion, improves vascular tone, and lowers blood pressure, with emerging mechanistic and clinical evidence supporting a complementary role for potassium in mitigating the adverse effects of high sodium intake.

Citing randomized trials, including the China Salt Substitute and Stroke Study, the authors argue that modest replacement of dietary sodium chloride with potassium-enriched salt substitutes could be a practical population-level strategy to lower blood pressure and cardiovascular risk. They note, however, that potassium-enriched salt substitutes are not appropriate for patients with advanced kidney disease, those taking potassium supplements or potassium-sparing diuretics, or others with contraindications.

Beyond encouraging greater consumption of fruits, vegetables, legumes, and dairy, the authors advocate for broader food industry efforts to reformulate products using potassium-containing salt substitutes where feasible. They also call for research to establish dietary reference intakes for potassium related to chronic disease prevention, improve consumer education, and evaluate policies that encourage both sodium reduction and potassium intake.

"It is time to view dietary interventions holistically because food components interact and physiology is integrative across systems," said lead author Naomi K. Fukagawa, MD, PhD, professor emerita of medicine at the University of Vermont. "Growing evidence shows that increasing dietary potassium as well as reducing sodium intake work together to better manage hypertension."

Source: Fukagawa NK, et al. (2026 Jul 30) Am J Clin Nutr. Rethinking the impact of dietary sodium and potassium on blood pressure to advance public health