Abstract
Background
The association between dietary sodium and potassium, the ratio of sodium to potassium,
and blood pressure remains unclear.
Objective
We evaluated the associations between blood pressure and dietary sodium and potassium
intake in terms of the amount and ratio in Korean adults.
Design
This cross-sectional study was based on data from the fourth and fifth Korean National
Health and Nutrition Examination Survey, 2007-2012.
Participants/setting
A total of 24,096 adults (aged ≥19 years) without history of antihypertensive medication
use were selected. The 24-hour recall method was used for dietary assessment. We categorized
the subjects into four groups using median intakes of sodium and potassium, and defined
the low sodium/high potassium intake group as the reference group.
Main outcome measures
High blood pressure (HBP) was defined as mean systolic or diastolic blood pressures
of ≥140 or ≥90 mm Hg, respectively.
Statistical analyses performed
Multivariate logistic regression was performed to estimate the odds ratio and 95%
CI to investigate the association between the four groups of sodium and potassium
intakes and HBP.
Results
Sodium intake was positively associated with diastolic blood pressure, with an increase
of 0.21 mm Hg per 1 mg/kcal increase in sodium (P<0.001). In contrast, potassium intake was negatively associated with systolic blood
pressure, with a decrease of 1.01 mm Hg per 1 mg/kcal increase in potassium (P<0.001). After adjusting for confounders, the high sodium/low potassium (odds ratio
1.21, 95% CI 1.02 to 1.44) and low sodium/low potassium intake groups (odds ratio
1.19, 95% CI 1.01 to 1.40) were at higher risk of HBP than the reference group. The
risk of HBP in the high sodium/high potassium group did not differ from that in the
reference group.
Conclusions
Low potassium intake was associated with an increased risk of hypertension. These
results suggest that increasing potassium intake might be beneficial for hypertension
control among populations with low-potassium diets.
Keywords
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References
- The impact of prevention on reducing the burden of cardiovascular disease.Diabetes Care. 2008; 31: 1686-1696
- Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: Prospective observational studies corrected for the regression dilution bias.Lancet. 1990; 335: 765-774
- Global burden of hypertension: Analysis of worldwide data.Lancet. 2005; 365: 217-223
- Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases.Physiol Rev. 2005; 85: 679-715
- Sodium intake and vascular stiffness in hypertension.Hypertension. 2009; 54: 203-209
- Sodium, potassium, body mass, alcohol and blood pressure: The INTERSALT Study.J Hypertens Suppl. 1988; 6: S584-S586
- Effect of longer-term modest salt reduction on blood pressure.Cochrane Database Syst Rev. 2013; 4: CD004937
- Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride.Cochrane Database Syst Rev. 2011; : CD004022
- Salt intake, stroke, and cardiovascular disease: Meta-analysis of prospective studies.BMJ. 2009; 339: b4567
- Effect of increased potassium intake on cardiovascular risk factors and disease: Systematic review and meta-analyses.BMJ. 2013; 346: f1378
- Dietary sodium and potassium intake is not associated with elevated blood pressure in US adults with no prior history of hypertension.J Clin Hypertens (Greenwich). 2014; 16: 418-423
- Dietary sodium, calcium, and potassium, and blood pressure.Am J Epidemiol. 1986; 123: 1043-1048
- The influence of oral potassium chloride on blood pressure in hypertensive men on a low-sodium diet.N Engl J Med. 1990; 322: 569-574
- High potassium intake blunts the effect of elevated sodium intake on blood pressure levels.J Am Soc Hypertens. 2014; 8: 232-238
- Potassium depletion exacerbates essential hypertension.Ann Intern Med. 1991; 115: 77-83
- The influence of potassium administration and of potassium deprivation on plasma renin in normal and hypertensive subjects.J Clin Invest. 1970; 49: 2128-2138
- Knowledge, beliefs, and behaviors about hypertension control among middle-aged Korean Americans with hypertension.J Community Health. 2007; 32: 324-342
- Sodium and potassium intake patterns and trends in South Korea.J Hum Hypertens. 2013; 27: 298-303
- Review and Updating of Current WHO Recommendations on Salt/Sodium and Potassium Consumption. World Health Organization, Geneva, Switzerland2011
World Health Organization. Diet, nutrition and the prevention of chronic disease. http://whqlibdoc.who.int/trs/who_trs_916.pdf. Accessed April 30, 2014.
- Effects of a 12-week lifestyle intervention on health outcome and serum adipokines in middle-aged Korean men with borderline high blood pressure.J Am Coll Nutr. 2012; 31: 352-360
- Translation and validation of the Dietary Approaches to Stop Hypertension for Koreans intervention: Culturally tailored dietary guidelines for Korean Americans with high blood pressure.J Cardiovasc Nurs. 2013; 28: 514-523
- Increasing prevalence of metabolic syndrome in Korea: The Korean National Health and Nutrition Examination Survey for 1998-2007.Diabetes Care. 2011; 34: 1323-1328
Ministry of Health and Welfare, Korean Centers for Disease Control and Prevention, Korea Health Industry Development Institute. Guideline for Nutrition Survey of the Korea National Health and Nutrition Examination Survey. https://knhanes.cdc.go.kr/knhanes/index.do. Accessed June 1, 2015.
- The relationship between dietary intake and urinary excretion of sodium, potassium, calcium and magnesium: Belgian Interuniversity Research on Nutrition and Health.J Hum Hypertens. 1990; 4: 527-533
National Rural Resources Development Institute. Rural Development Administration. Food Composition Table. 7th ed. 2006. http://koreanfood.rda.go.kr/kfi/fct/fctPdfDwn/view. Accessed June 1, 2015.
- 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8).JAMA. 2014; 311: 507-520
- The epidemiology of alcohol use disorders.J Korea Diabet. 2012; 13: 69
The Korean Centers for Disease Control and Prevention. Health information service. http://www.cancer.go.kr/mbs/cancer/subview.jsp?id=cancer_010104040000. Accessed June 1, 2015.
- Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.Circulation. 2007; 116: 1081-1093
- Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.N Engl J Med. 2001; 344: 3-10
- New evidence relating to the health impact of reducing salt intake.Nutr Metab Cardiovasc Dis. 2011; 21: 617-619
- Relationship between dietary sodium, potassium, and calcium, anthropometric indexes, and blood pressure in young and middle aged Korean adults.Nutr Res Pract. 2010; 4: 155-162
- Increasing sensitivity of blood pressure to dietary sodium and potassium with increasing age. A population study using casual urine specimens.Am J Hypertens. 1990; 3: 505-511
- Sodium and volume sensitivity of blood pressure. Age and pressure change over time.Hypertension. 1991; 18: 67-71
- Association between usual sodium and potassium intake and blood pressure and hypertension among U.S. adults: NHANES 2005-2010.PLoS One. 2013; 8: e75289
- Understanding the patterns and trends of sodium intake, potassium intake, and sodium to potassium ratio and their effect on hypertension in China.Am J Clin Nutr. 2014; 99: 334-343
- The effects of potassium depletion and supplementation on blood pressure: A clinical review.Am J Med Sci. 1997; 314: 37-40
- Dietary sodium affects systemic and renal hemodynamic response to NO inhibition in healthy humans.Am J Physiol. 1998; 274: F914-F923
- Transforming growth factor-beta-induced growth inhibition and cellular hypertrophy in cultured vascular smooth muscle cells.J Cell Biol. 1988; 107: 771-780
- Potassium inhibits dietary salt-induced transforming growth factor-beta production.Hypertension. 2009; 54: 1159-1163
- Salt intakes around the world: Implications for public health.Int J Epidemiol. 2009; 38: 791-813
- Potassium and fruit and vegetable intakes in relation to social determinants and access to produce in New York City.Am J Clin Nutr. 2013; 98: 1282-1288
- Descriptive characteristics of the dietary patterns used in the Dietary Approaches to Stop Hypertension Trial. DASH Collaborative Research Group.J Am Diet Assoc. 1999; 99: S19-S27
- Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: A randomised controlled trial.Lancet. 2002; 359: 1969-1974
- Vitamin C and blood pressure—An overview.J Hum Hypertens. 1997; 11: 343-350
- Dietary approaches to prevent and treat hypertension: A scientific statement from the American Heart Association.Hypertension. 2006; 47: 296-308
- Lack of long-term effect of vitamin C supplementation on blood pressure.Hypertension. 2002; 40: 797-803
- Statistical issues in analyzing 24-hour dietary recall and 24-hour urine collection data for sodium and potassium intakes.Am J Epidemiol. 2001; 153: 996-1006
- Measurement error corrected sodium and potassium intake estimation using 24-hour urinary excretion.Hypertension. 2014; 63: 238-244
Biography
H.-M. Noh is a fellow, Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
Biography
H.-Y. Oh is a fellow, Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
Biography
S.-Y. Park is a resident physician, Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
Biography
Y. J. Paek is a professor, Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
Biography
H. J. Song is a professor, Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
Biography
K. H. Park is an associate professor, Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
Biography
H.-S. Lee is head researcher, Nutrition Policy and Promotion Team, Korea Health Industry Development Institute, Chungcheongbukdo, Republic of Korea.
Article info
Publication history
Published online: June 27, 2015
Accepted:
April 22,
2015
Received:
November 19,
2014
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT None to report.
Identification
Copyright
© 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
