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Meta-Analysis
. 2013 Apr 3:346:f1378.
doi: 10.1136/bmj.f1378.

Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses

Nancy J Aburto  1 , Sara Hanson, Hialy Gutierrez, Lee Hooper, Paul Elliott, Francesco P Cappuccio
Affiliations
Meta-Analysis

Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses

Nancy J Aburto et al. BMJ. .

Abstract

Objective: To conduct a systematic review of the literature and meta-analyses to fill the gaps in knowledge on potassium intake and health.

Data sources: Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, Latin American and Caribbean Health Science Literature Database, and the reference lists of previous reviews.

Study selection: Randomised controlled trials and cohort studies reporting the effects of potassium intake on blood pressure, renal function, blood lipids, catecholamine concentrations, all cause mortality, cardiovascular disease, stroke, and coronary heart disease were included.

Data extraction and synthesis: Potential studies were independently screened in duplicate, and their characteristics and outcomes were extracted. When possible, meta-analysis was done to estimate the effects (mean difference or risk ratio with 95% confidence interval) of higher potassium intake by using the inverse variance method and a random effect model.

Results: 22 randomised controlled trials (including 1606 participants) reporting blood pressure, blood lipids, catecholamine concentrations, and renal function and 11 cohort studies (127,038 participants) reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease in adults were included in the meta-analyses. Increased potassium intake reduced systolic blood pressure by 3.49 (95% confidence interval 1.82 to 5.15) mm Hg and diastolic blood pressure by 1.96 (0.86 to 3.06) mm Hg in adults, an effect seen in people with hypertension but not in those without hypertension. Systolic blood pressure was reduced by 7.16 (1.91 to 12.41) mm Hg when the higher potassium intake was 90-120 mmol/day, without any dose response. Increased potassium intake had no significant adverse effect on renal function, blood lipids, or catecholamine concentrations in adults. An inverse statistically significant association was seen between potassium intake and risk of incident stroke (risk ratio 0.76, 0.66 to 0.89). Associations between potassium intake and incident cardiovascular disease (risk ratio 0.88, 0.70 to 1.11) or coronary heart disease (0.96, 0.78 to 1.19) were not statistically significant. In children, three controlled trials and one cohort study suggested that increased potassium intake reduced systolic blood pressure by a non-significant 0.28 (-0.49 to 1.05) mm Hg.

Conclusions: High quality evidence shows that increased potassium intake reduces blood pressure in people with hypertension and has no adverse effect on blood lipid concentrations, catecholamine concentrations, or renal function in adults. Higher potassium intake was associated with a 24% lower risk of stroke (moderate quality evidence). These results suggest that increased potassium intake is potentially beneficial to most people without impaired renal handling of potassium for the prevention and control of elevated blood pressure and stroke.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: LH, FPC, and PE received funding from WHO to attend NUGAG Subgroup of Diet and Health meetings; PE receives support from the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London; FPC is an unpaid member of Consensus Action on Salt and Health and World Action on Salt and Health, an unpaid advisor to WHO and the PAHO, an individual member of the National Heart Forum, and a former member of the Executive Committee and trustee of the British Hypertension Society; PE is an unpaid member of CASH and WASH and an unpaid advisor to WHO; no further financial support from any organisation for the submitted work that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. NJA was a staff member of the WHO at the time this work was completed; the author alone is responsible for the views expressed in this publication, and they do not necessarily represent the views, decisions, or policies of WHO.

Figures

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Fig 1 Flow of studies through screening, inclusion, and exclusion. RCT=randomised controlled trial
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Fig 2 Effect of increased potassium intake on resting systolic blood pressure in adults: by hypertension status and total
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Fig 3 Effect of increased potassium intake on resting diastolic blood pressure in adults: by hypertension status and total
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Fig 4 Association between higher potassium intake and risk of incident cardiovascular disease, stroke, and coronary heart disease in adults
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Fig 5 Effect of increased potassium intake on blood lipid concentrations, catecholamine concentrations, and renal function in adults
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Fig 6 Effect of increased potassium intake on resting systolic blood pressure in children. Sinaiko 1993 reported results for boys and girls separately, and Wilson 1996 reported results for two groups separately on basis of their change in blood pressure between waking and sleeping hours during pilot phase of study
See this image and copyright information in PMC

Comment in

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