Experts say blood pressure guidelines are missing half the equation

High blood pressure, also known as hypertension, affects more than 1.28 billion adults around the world. It is also a major risk factor for cardiovascular disease. Current public health recommendations generally emphasize reducing sodium as the primary dietary step for lowering blood pressure and protecting heart health.

Looking Beyond Sodium Reduction

The physicians and health experts behind the report argue that lowering sodium may have a greater effect when it is paired with increased potassium intake. Potassium can also be used as a substitute for some of the sodium in salt.

According to the researchers, growing evidence about potassium's role in blood pressure regulation supports a major change in public health guidance. Rather than considering sodium and potassium separately, recommendations should address how the two nutrients work together.

"It is time to view dietary interventions holistically because food components interact and physiology is integrative across systems" said Naomi Fukagawa, M.D. Ph.D, professor of medicine emerita at the Robert Larner, M.D. College of Medicine at the University of Vermont and first author on the report. "Growing evidence shows that increasing dietary potassium as well as reducing sodium intake work together to better manage hypertension."

A New Framework for Hypertension Guidance

The peer-reviewed report was published in the American Journal of Clinical Nutrition and was supported by the IAFNS Sodium in Food and Health Implications Committee.

It reviews the evidence behind current sodium and potassium intake recommendations, possible methods for reducing sodium and increasing potassium, obstacles to putting those strategies into practice, and future research and policy priorities that could improve public health.

Too much sodium and too little potassium are both major dietary factors that can be changed to help reduce elevated blood pressure. Average sodium consumption continues to exceed recommended levels, while potassium intake is frequently "far below optimal levels in both developed and developing nations," according to the authors.

Foods That Supply More Potassium

Fruits, vegetables, legumes and dairy products are among the main dietary sources of potassium.

Food manufacturers can also replace some sodium with potassium salts, but there are practical limits. When too much potassium salt is added, foods can develop a metallic taste. Manufacturers therefore have to carefully balance sodium reduction with potassium enhancement when reformulating products.

The authors conclude that "dietary sodium reduction is a foundational strategy for hypertension prevention and management. However, new evidence supports a broadening of the current approach that focuses solely on sodium reduction and provides equal emphasis on increasing potassium intake."