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Want to learn more about why potassium is important for your patients with hypertension?

Keep reading for the scientific evidence supporting potassium replacement for your patients

Section 1: Epidemiology

Population studies in the U.S. and around the world show that potassium deficiency is widespread.

Median daily intake in the U.S.

2,300mg daily

Potassium Excretion (g/day)
NHANES 2003–2018, 13,855 participants
Source: NEJM 2014; 371(7): 612

Median daily intake across 17 countries

2,000mg daily

Potassium Intake (mg)
101,945 patients from 17 countries
Source: BMC Public Health (2024) 24:180

Most of your patients are deficient in potassium relative to expert guidelines

2,300 mg

Average American

In a study of 12,000 Americans, less than 2% got the amount of potassium recommended by experts. The average intake was only 2,300 mg per day

4,700 mg

Recommended daily intake

  • American College of Cardiology 5,000 mg daily
  • National Kidney Foundation 4,700 mg daily
  • Food & Drug Administration 4,700 mg daily

Section 2: Mechanism of Action

Clinical research shows us that potassium controls blood pressure through two discrete mechanisms

1. Down-regulation of the Renin-Angiotensin-Aldosterone System (RAAS)

Human intervention trials show that increasing daily urinary potassium excretion to 100 mmol (3,900 mg) can supress renin secretion. Decreases in renin downregulate the RAAS, leading to increased excretion of sodium and water.

As potassium intake increases, renin secretion decreases

Source: Brunner et al. The Influence of Potassium Administration and of Potassium Deprivation on Plasma Renin in Normal and Hypertensive Subjects. The Journal of Clinical Investigation 1970;49: 2128-2138

Source: Maebashi, M., Y. Miura, and K. Yoshinaga. 1968. Suppressive effect of potassium on renin release. Jap. Circ. J. 32: 1265.

Source: Veyrat, R., H. R. Brunner, E. L. Manning, and A. F. Muller. 1967. Inhibition de l'activite de la renine plasmatique par le potassium. J. Urol. Nephrol. 73: 271.

Excerpt from the 2017 ACC/AHA Task Force on Clinical Practice Guidelines

Potassium intake is inversely related to BP in migrant, cross-sectional, and prospective cohort studies. It is also inversely related to stroke. A higher level of potassium seems to blunt the effect of sodium on BP, with a lower sodium–potassium ratio being associated with a lower level of BP than that noted for corresponding levels of sodium or potassium on their own. Likewise, epidemiological studies suggest that a lower sodium–potassium ratio may result in a reduced risk of CVD as compared with the pattern for corresponding levels of either cation on its own.

Whelton et al. 2017 High Blood Pressure Clinical Practice Guideline. JACC, 2018; 71(19): e127–248

2. Dephosphorylation of the Sodium Chloride Co-transporter (NCC)

The NCC in the distal tubule acts to retain sodium, chloride and water when in its phosphorylated active state. Low dietary intake of K triggers the phosphorylation of NCC, while higher intakes of K result in dephosphorylation of the NCC, allowing for the excretion of excess sodium and water.

Section 3: Efficacy

Potassium supplementation has similar effect to medications that target the RAAS

  1. Source: PLoS ONE 12(4):e0174967
  2. Source: Cochrane Database of Systematic Reviews 2008, Issue 4.Art. No.: CD003822.
  3. Source: Cochrane Database of Systematic Reviews 2008, Issue 4.Art. No.: CD003823.
  4. Source: Cochrane Database of Systematic Reviews 2014, Issue 5.Art. No.: CD003824
  5. Source: Cochrane Database of Systematic Reviews 2022, Issue 11.Art. No.: CD015250
  6. Source: Cochrane Database of Systematic Reviews 2014, Issue 5.Art. No.: CD003824.

Large meta-analyses support the clinical benefits of potassium supplementation in patients with hypertension

The NCC in the distal tubule acts to retain sodium, chloride and water when in its phosphorylated active state. Low dietary intake of K triggers the phosphorylation of NCC, while higher intakes of K result in dephosphorylation of the NCC, allowing for the excretion of excess sodium and water.

19 trials with over 580 participants showed an average 8 point reduction in BP, with a maximal lowering of 39 points

Source: Cappuccio, F. and MacGregor, G. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. Journal of Hypertension 1991; 9: 465-473

23 trials with over 1,200 participants showed an average 9 point reduction in BP, with a maximal lowering of 13 points

Source: Poorolajal J, et al. Oral potassium supplementation for management of essential hypertension: A meta-analysis of randomized controlled trials. PLoS ONE 12(4):e0174967

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