When High Sodium Meets Low Potassium: Dietary Patterns Associated with Sodium–Potassium Imbalance in Saudi Adults

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Background/Objectives: Excess sodium and inadequate potassium are interrelated dietary determinants of blood pressure (BP). Evidence on concurrent intake, food-group patterns, and BP in Saudi adults remains limited. We aimed to characterize sodium and potassium intakes and the sodium-to-potassium (Na:K) ratio, associated food-group patterns, and BP across tertiles. Methods: This cross-sectional secondary analysis included 1041 Saudi adults recruited in 2021–2023. Intakes were estimated from two nonconsecutive multiple-pass 24 h recalls; food-group densities were expressed as g/1000 kcal. BP was measured using a standardized protocol, and the mean of three readings was analyzed. Models adjusted for age, sex, total energy, body mass index, smoking status, and family history of hypertension examined BP across Na:K tertiles and food-group density associations. Results: In this cohort, 96.7% reported sodium intake ≥2000 mg/day, 86.1% potassium intake <3510 mg/day, and 82.9% had both. Geometric mean sodium intake was 4750 mg/day (95% CI 4600–4900), and potassium intake was 2330 mg/day (2270–2390). Adjusted systolic BP was 2.28 mmHg and diastolic BP 2.10 mmHg higher in the highest versus lowest tertile. A higher ratio was associated with greater densities of breads and grains, soft drinks, animal-protein foods, and fast food, and lower densities of fruit, vegetables, dairy, plant-protein foods, fats and oils, and juice and fruit drinks. Fruit showed the strongest inverse association (standardized β = −0.31, 95% CI −0.39 to −0.24). Conclusions: Excessive sodium and inadequate potassium commonly coexisted in our cohort. A higher Na:K ratio was associated with higher systolic and diastolic BP and a broader dietary pattern. These findings support reducing sodium and promoting potassium-rich foods, although the cross-sectional design precludes causal inference.