Effect of Change Potassium Intake on Systolic Blood Pressure: A Dose-Response Meta-Analysis of Randomized Clinical Trials (2000-2024)
Authors: Granal Maelys , Sourd Victoria , Burnier Michel , Fauvel Jean Pierre , Gougeon Arthur 
Published: November 2024

Background

The global prevalence of hypertension in adults has doubled in 30 years, rising from 650 million to 1.3 billion between 1990 and 2019. Although reducing sodium intake is one of the first core of non-pharmacological hypertension management guidelines, recent guidelines strongly emphasize the need for increased potassium intake due to accumulating evidence of its cardiovascular benefits.

Methods

We conducted a systematic review to identify randomized controlled trials evaluating the effect of potassium supplementation (measured through 24-hour urinary potassium excretion) on systolic blood pressure. A dose-response meta-analysis was performed using three regression models: linear, quadratic and one-stage cubic spline. Subgroup analyses were performed according to hypertensive or normotensive status.

Results

The meta-analysis included 10 randomized clinical trials comprising 4 studies in normotensive individuals and 6 in hypertensive patients. The dose-response relationship differed based on participants’ blood pressure status. Subgroup analyses revealed a weak negative linear effect of potassium on systolic blood pressure in normotensive individuals, while a stronger negative linear relationship was observed in hypertensive patients. The dose-response meta-analysis predicted that for a 50 mmol increase in urinary potassium excretion over 24 hours, systolic blood pressure decreased by 0.5 mmHg in the normotensive group and by 5.3 mmHg in the hypertensive group.

Conclusion

These meta-analysis results confirm a dose-response relationship between potassium supplementation and systolic blood pressure reduction, particularly in individuals with hypertension. Predictions should be viewed with caution due to the limited number of studies included in the study.

Novelty and relevance

What is new?

The dose-response relationship between change in potassium intake and change in systolic blood pressure was described using three statistical models (linear, quadratic and cubic spline) to avoida prioriassumptions.

The dose-response meta-analysis revealed a weak linear relationship between increased potassium intake and decreased systolic blood pressure in normotensive individuals. The effect was more pronounced in hypertensive patients.

What is relevant?

The meta-analysis specifically addresses the impact of change in potassium intake on change in systolic blood pressure selecting only recent (since the 2000s), high-quality randomized clinical trials in witch potassium intake was accurately estimated through 24-hour urinary potassium excretion. The included studies underwent rigorous assessment of bias. These analyses stratified by normotensive or hypertensive status align with current therapeutic and nutritional management practices, as well as recent diagnostic methods (measuring devices, thresholds). These findings aim to facilitate decision-making for future national and international nutritional recommendations.

Clinical/pathophysiological implications?

The results of this dose-response meta-analysis support current nutritional recommendations to increase dietary potassium intake to lower blood pressure, particularly in hypertensive patients. Improved potassium intake management could significantly improve blood pressure control and reduce cardiovascular risk, particularly in high-risk hypertensive patients.