Cardiovascular benefits associated with higher dietary K+ vs. lower dietary Na+: evidence from population and mechanistic studies

Am J Physiol Endocrinol Metab. 2017 Apr 1;312(4):E348-E356. doi: 10.1152/ajpendo.00453.2016. Epub 2017 Feb 7.


The World Health Organization ranks hypertension the leading global risk factor for disease, specifically, cardiovascular disease. Blood pressure (BP) is higher in Westernized populations consuming Na+-rich processed foods than in isolated societies consuming K+-rich natural foods. Evidence suggests that lowering dietary Na+ is particularly beneficial in hypertensive individuals who consume a high-Na+ diet. Nonetheless, numerous population studies demonstrate a relationship between higher dietary K+, estimated from urinary excretion or dietary recall, and lower BP, regardless of Na+ intake. Interventional studies with K+ supplementation suggest that it provides a direct benefit; K+ may also be a marker for other beneficial components of a "natural" diet. Recent studies in rodent models indicate mechanisms for the K+ benefit: the distal tubule Na+-Cl- cotransporter (NCC) controls Na+ delivery downstream to the collecting duct, where Na+ reabsorbed by epithelial Na+ channels drives K+ secretion and excretion through K+ channels in the same region. High dietary K+ provokes a decrease in NCC activity to drive more K+ secretion (and Na+ excretion, analogous to the actions of a thiazide diuretic) whether Na+ intake is high or low; low dietary K+ provokes an increase in NCC activity and Na+ retention, also independent of dietary Na+ Together, the findings suggest that public health efforts directed toward increasing consumption of K+-rich natural foods would reduce BP and, thus, cardiovascular and kidney disease.

Keywords: ENaC; NCC; dietary potassium; dietary sodium; hypertension.

Publication types

  • Review
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Blood Pressure / physiology*
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / prevention & control*
  • Humans
  • Kidney / physiopathology*
  • Potassium, Dietary*
  • Sodium, Dietary*


  • Potassium, Dietary
  • Sodium, Dietary