Effects of Potassium Chloride and Potassium Bicarbonate on Endothelial Function, Cardiovascular Risk Factors, and Bone Turnover in Mild Hypertensives

Abstract

Abstract-To determine the effects of potassium supplementation on endothelial function, cardiovascular risk factors, and bone turnover and to compare potassium chloride with potassium bicarbonate, we carried out a 12-week randomized, double-blind, placebo-controlled crossover trial in 42 individuals with untreated mildly raised blood pressure. Urinary potassium was 77Ϯ16, 122Ϯ25, and 125Ϯ27 mmol/24 hours after 4 weeks on placebo, potassium chloride, and potassium bicarbonate, respectively. There were no significant differences in office blood pressure among the 3 treatment periods, and only 24-hour and daytime systolic blood pressures were slightly lower with potassium chloride. Compared with placebo, both potassium chloride and potassium bicarbonate significantly improved endothelial function as measured by brachial artery flow-mediated dilatation, increased arterial compliance as assessed by carotid-femoral pulse wave velocity, decreased left ventricular mass, and improved left ventricular diastolic function. There was no significant difference between the 2 potassium salts in these measurements. The study also showed that potassium chloride reduced 24-hour urinary albumin and albumin:creatinine ratio, and potassium bicarbonate decreased 24-hour urinary calcium, calcium:creatinine ratio, and plasma C-terminal cross-linking telopeptide of type 1 collagen significantly. These results demonstrated that an increase in potassium intake had beneficial effects on the cardiovascular system, and potassium bicarbonate may improve bone health. Importantly, these effects were found in individuals who already had a relatively low-salt and high-potassium intake. (Hypertension. 2010;55:681-688.)Key Words: potassium chloride Ⅲ potassium bicarbonate Ⅲ endothelial function Ⅲ cardiovascular risk factors Ⅲ bone turnover Ⅲ randomized trial M any randomized trials have shown that an increase in potassium intake lowers blood pressure (BP), particularly in individuals with raised BP. 1 Increasing evidence also suggests that a higher potassium intake may have beneficial effects on endothelial function, renal disease, arterial compliance, left ventricular (LV) mass and function, and bone mineral density. 2 The evidence for many of these effects is mainly from experimental studies in animals, and few wellcontrolled trials have studied such effects in humans.Most previous studies on potassium have used potassium chloride, which is convenient for making the study double blinded by using slow-release potassium chloride versus slow-release potassium chloride placebo. 1 These studies have demonstrated clear benefits of potassium chloride, particularly on BP. Increasing potassium intake has been recommended as an important approach to lowering BP not only in individuals with raised BP but also in those with normal BP. However, no one is suggesting that the whole population take potassium chloride supplements. The best way to increase potassium intake is to increase the consumption of foods that are high in potassium, for example, fruit and ve...

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