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

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.

Fig 1 Flow of studies through screening, inclusion, and exclusion. RCT=randomised controlled trial

Fig 2 Effect of increased potassium intake on resting systolic blood pressure in adults: by hypertension status and total

Fig 3 Effect of increased potassium intake on resting diastolic blood pressure in adults: by hypertension status and total

Fig 4 Association between higher potassium intake and risk of incident cardiovascular disease, stroke, and coronary heart disease in adults

Fig 5 Effect of increased potassium intake on blood lipid concentrations, catecholamine concentrations, and renal function in adults

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