Moderate potassium chloride supplementation in essential hypertension: is it additive to moderate sodium restriction?

Smith, S J; Markandu, Nirmala D.; Sagnella, Giuseppe A.; Macgregor, G. A.

doi:10.1136/bmj.290.6462.110

Cited by 76 publications

(47 citation statements)

References 21 publications

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“…However, the hypotensive effect of high K diets has not been uni formly observed [23][24][25][26], and its long-term effect is still disputable [27], Furthermore, the effect seems to be sub ject to the influence of other concomitant factors such as an amount of Na intake, an amount of K in the basic diet or a severity of hypertension [20,21,25,26,[28][29][30]. In the present study, the 2.1% high K diet slightly lowered the blood pressure of salt-fed SHRsp as compared with the 0.5% normal K diet.…”

Section: Discussionmentioning

confidence: 99%

High Potassium Diets Reduce Macrophage Adherence to the Vascular Wall in Stroke-Prone Spontaneously Hypertensive Rats

et al. 1995

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Our previous study demonstrated that high potassium (K) diets reduce stroke mortality in stroke-prone spontaneously hypertensive rats (SHRsp) even when the blood pressure is not lowered. On the other hand, macrophage infiltration into the vascular wall is known to play an important role in the development of arterial lesions. In this study, in vivo and in vitro experiments were performed to examine the effect of high K diets on macrophage adherence to the vascular wall in SHRsp rats. In the in vivo study, ⁵¹Cr-labelled macrophages, collected from the peritoneal cavity, were injected intravenously to SHRsp rats fed 6% high NaCl diets containing either normal 0.5% K or high 2.1 % K, and, 45 min later, the rats were perfused with buffered saline to remove blood. Radioactivity from macrophages in the aorta was 40% lower in the high K SHRsp than in the normal K SHRsp (p < 0.002), and the brain of high K SHRsp also showed a 52% lower macrophage radioactivity than that of normal K SHRsp (p < 0.007). Although the mean blood pressure was slightly lower in the high K diet group than in the normal K diet group (167 vs. 184 mm Hg), these differences remained still prominent even when we compared groups with matching blood pressures; –33% for the aorta (p < 0.02) and –55% for the brain (p < 0.02). In the in vitro study, the aortas of SHRsp rats similarly fed on normal or high K diet were excised and mounted in a perfusion chamber. They were perfused with labelled macrophages at normotensive or hypertensive pressure. In normal K SHRsp, macrophage radioactivity remained in the washed aorta was 158% higher in high perfusion pressure group than in normal pressure (p < 0.002). However, they did not significantly differ between two perfusion pressures in high K SHRsp. These results indicate that high K diets reduce endothelial injuries which allow adherence and infiltration of macrophages into the vascular wall of hypertensive animals, and thereby contribute to the reduction of vascular lesions and stroke mortality.

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Section: Discussionmentioning

confidence: 99%

High Potassium Diets Reduce Macrophage Adherence to the Vascular Wall in Stroke-Prone Spontaneously Hypertensive Rats

et al. 1995

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“…141617 However, many studies have not found any association between potassium intake (assessed by urinary potassium excretion) and blood pressure. 25 ' 27 -29 - 34 Smith et al 40 have suggested, based on their observation that no additional decrease in blood pressure was observed when potassium was added to a diet restricted to 70 mmol sodium/day, that the effect of potassium may be related to sodium intake.…”

Section: ^5mentioning

confidence: 99%

Relation of electrolytes to blood pressure in men. The Yi people study.

Tell

Tang

et al. 1991

Hypertension

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The relations of sodium, potassium, calcium, and magnesium to blood pressure were investigated in four groups of men (119 high-mountain Yi farmers, 114 mountainside Yi farmers, 89 Yi migrants, and 97 Han people) with a wide range of electrolyte intake in Puge County, Sichuan Province, People's Republic of China. Electrolytes were measured in diet, serum, and urine. Sodium excretion was 73.9 mmol/24 hr in high-mountain Yi farmers, 117.9 mmol/24 hr in mountainside Yi farmers, 159.4 mmol/24 hr in Yi migrants, and 186.0 mmol/24 hr in the Han people. In ecological correlation analysis, dietary and urinary sodium were significantly and positively correlated with both systolic and diastolic pressure, whereas serum sodium showed no relation with blood pressure. In diet, serum, and urine, potassium was negatively related to systolic and diastolic pressure, whereas the sodium/potassium ratio showed a positive association. With regard to calcium, only urinary excretion was significantly and positively related to blood pressure. No relation was found between magnesium and blood pressure. Analyses at the individual level confirmed the results for sodium and potassium seen at the ecological level, but in addition, dietary calcium and magnesium were significantly and negatively correlated to both systolic and diastolic pressure, and urinary magnesium was inversely related to diastolic pressure. These relations persisted after controlling for age, body mass index (kg/m 2 ), heart rate, alcohol, and total energy intake in multiple regression analysis performed separately for electrolytes in diet, serum, and urine. In multiple regression analysis, an increase in sodium intake of 100 mmol/day corresponded to an increase of 2 3 mm Hg systolic blood pressure and 1.8 mm Hg diastolic pressure. An increase in potassium intake of 100 mmol/day corresponded to an 8 3 mm Hg decrease in systolic blood pressure and a 5.7 mm Hg decrease in diastolic pressure. Using the ratio of urinary sodium, potassium, calcium, and magnesium to creatinine as the independent variables confirmed the previous results, with the addition of a significant inverse relation of magnesium/creatinine ratio to both systolic and diastolic blood pressure. These results are consistent with the view that a diet low in sodium and high in potassium, calcium, and magnesium may prevent the development of hypertension. (Hypertension 1991;17378-385)

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“…However, half of the 12 patients studied by Richards et al had some rise in their intra-arterial diastolic blood pressures after potassium supplementation. More recently, the addition of 64 mmol per day of potassium was found to have no additive antihypertensive effect beyond that observed when the patients were given a diet moderately restricted in sodium (58).…”

Section: Controlled Trialsmentioning

confidence: 99%

Dietary Aspects of the Treatment of Hypertension

Kaplan¹

1986

Annual Review of Public Health

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Hypertension may or may not be more common today than in the past, distant or recent. Regardless, it is the most prevalent risk factor for premature car diovascular disease, and, since cardiovascular diseases are the leading cause of death in the United States and all industrialized countries, hypertension can correctly be called our major public health problem (24).As seen in Figure 1, the total estimated hypertensive population in the United States now numbers some 30 million people. Though some would add another 20 or more million to this number by including all with diastolic levels between 90 and 95 mm Hg, as well as those between 85 and 90, I believe the criteria used in the NHANES study-systolic above 160 and/or diastolic above 95 mm Hg-are more appropriate, since as many as one third of those with diastolic readings above 95 mm Hg are below 90 mm Hg on repeated readings (25). I do not address further the issue about variability of the blood pressure. I raise the issue simply to remind all interested in Public Health that there is no benefit and a great deal of potential harm in the use of such loose criteria as to label and treat many who are not and never will be hypertensive.Beyond the number of hypertensives, the percentages given in Figure 1 on the number of hypertensives on therapy and under adequate control must disturb all who have been lulled into assuming that the war on hypertension has been won because of the marked fall in death rates for both heart attack and stroke that have occurred since 1968. Despite all of the efforts expended against it over the past 25 years, hypertension remains frequently untreated and infrequently well controlled..

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Moderate potassium chloride supplementation in essential hypertension: is it additive to moderate sodium restriction?

Cited by 76 publications

References 21 publications

High Potassium Diets Reduce Macrophage Adherence to the Vascular Wall in Stroke-Prone Spontaneously Hypertensive Rats

High Potassium Diets Reduce Macrophage Adherence to the Vascular Wall in Stroke-Prone Spontaneously Hypertensive Rats

Relation of electrolytes to blood pressure in men. The Yi people study.

Dietary Aspects of the Treatment of Hypertension

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