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

Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP - BMJ (2013)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Nutrition Policy and Scientific Advice Unit, Department of Nutrition for Health and Development, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. nancy.aburto@wfp.org

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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Fig 2 Effect of increased potassium intake on restingsystolic blood pressure in adults: by hypertension status andtotal
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fig2: Fig 2 Effect of increased potassium intake on restingsystolic blood pressure in adults: by hypertension status andtotal

Mentions: Twenty one randomised controlled trials contributed 21 comparisons to themeta-analyses of resting blood pressure in adults. Increased potassiumintake reduced systolic blood pressure by 5.93 (95% confidence interval 1.70to 10.15) mm Hg and diastolic blood pressure by 3.78 (1.43 to 6.13) mm Hg.Heterogeneity was present in both analyses: I2=96% for thesystolic blood pressure analysis and I2=93% for the diastolicblood pressure analysis. We independently removed each study from theanalyses to explore the effect on the heterogeneity. We were able to reducethe I2 to 65% in the systolic blood pressure analysis by removingone study,52 and we reducedI2 to 55% in the diastolic analysis by removing twostudies.5152 Increased potassium intakereduced systolic blood pressure by 3.49 (1.82 to 5.15) mm Hg (fig 2) and diastolic blood pressure by 1.96 (0.86to 3.06) mm Hg (fig 3).


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

Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP - BMJ (2013)

Fig 2 Effect of increased potassium intake on restingsystolic blood pressure in adults: by hypertension status andtotal
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4816263&req=5

fig2: Fig 2 Effect of increased potassium intake on restingsystolic blood pressure in adults: by hypertension status andtotal
Mentions: Twenty one randomised controlled trials contributed 21 comparisons to themeta-analyses of resting blood pressure in adults. Increased potassiumintake reduced systolic blood pressure by 5.93 (95% confidence interval 1.70to 10.15) mm Hg and diastolic blood pressure by 3.78 (1.43 to 6.13) mm Hg.Heterogeneity was present in both analyses: I2=96% for thesystolic blood pressure analysis and I2=93% for the diastolicblood pressure analysis. We independently removed each study from theanalyses to explore the effect on the heterogeneity. We were able to reducethe I2 to 65% in the systolic blood pressure analysis by removingone study,52 and we reducedI2 to 55% in the diastolic analysis by removing twostudies.5152 Increased potassium intakereduced systolic blood pressure by 3.49 (1.82 to 5.15) mm Hg (fig 2) and diastolic blood pressure by 1.96 (0.86to 3.06) mm Hg (fig 3).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Nutrition Policy and Scientific Advice Unit, Department of Nutrition for Health and Development, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. nancy.aburto@wfp.org

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.

Show MeSH
Related in: MedlinePlus