Suboptimal Potassium Intake and Potential Impact on Population Blood Pressure

S mall reductions in blood pressure (BP) on a popu- lation level could have a substantial impact on cardiovascular disease risk. 1 This is especially relevant considering that the majority of the population has suboptimal BP levels.Dietary sodium reduction is a clearly established lifestyle change that has great potential to improve public health.Potassium, on the contrary, received much less attention.Nevertheless, a substantial body of data shows that increasing potassium intake lowers BP. 2 We reviewed population data on potassium intake and estimated the potential impact of increased potassium intake on population BP levels.Methods.We searched PubMed and contacted health authorities worldwide for national population-based dietary surveys conducted from 1990 to 2009 that included data on potassium intake in more than 1000 adults.We defined the recommended level of potassium intake at 4.7 g/d, based on the Dietary Reference Intakes from the Institute of Medicine. 2 The effect of dietary potassium on systolic BP was set at 1.0-mm Hg reduction per 0.6 g/d increase in intake, based on estimates from the INTERSALT study, 3 and we assumed this relation to be linear.5]67 For these countries we estimated the potential impact of increasing potassium intakes on population systolic BP levels and classification in different systolic BP categories, assuming a uniform shift in the population BP distribution, independent of initial BP level. Results.In 21 countries spread across North America, Europe, Asia, and Oceania, the mean potassium intakes ranged from 1.7 g/d (China) to 3.7 g/d (Finland, the Netherlands, and Poland) (Figure ) (references and data are available at http://www.wageningenuniversity.nl/UK/newsagenda/news/).Mean intakes in women were generally lower than in men.Based on our assumptions and intake data from Finland, the United Kingdom, and the United States, a hypothetical increase in potassium intake to 4.7 g/d would shift the population systolic BP distributions to 1.7-to 3.2-mm Hg lower levels in Western countries.This is in the same order of what can be predicted for a reduction in salt intake from 9 to 5 g/d.This theoretical increase in potassium intake in these countries would increase the percentage of men and women in the optimal systolic BP category (Ͻ120 mm Hg) by approximately 2% to 5% and 4% to 8%, respectively, and decrease the percentage of men and women with systolic BP levels in the higher range (Ն140 mm Hg) by approximately 2% to 5% and 4%, respectively.Comment.Increasing current potassium intakes in populations to recommended levels may lower population systolic BP in Western countries by 1.7 to 3.2 mm Hg, which can be predicted to reduce the risk of stroke mortality by 8% to 15% and the risk of heart disease mortality by 6% to 11%. 1 This is of similar magnitude to what can be achieved by lowering sodium intake and high-